401k Plan data: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN plan

MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 401k Plan overview

Plan Name	MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN
Plan identification number	511

MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN Benefits

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

401k Sponsoring company profile

MULTI-CARE SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: MULTI-CARE SERVICES, INC.

Employer identification number (EIN): 341629769

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2022-01-01
511 2021-01-01
511 2020-01-01
511 2019-01-01
511 2018-01-01
511 2017-01-01 MORTON WEISBERG
511 2016-01-01 MORTON WEISBERG
511 2015-01-01 MORTON WEISBERG
511 2014-01-01 MORTON WEISBERG
511 2013-01-01 MORTON WEISBERG
511 2012-01-01 MORTON WEISBERG
511 2011-01-01 LYNDA BOWER
511 2009-01-01 LYNDA BOWER

Plan Statistics for MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN

401k plan membership statisitcs for MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN

Measure Date Value
2022: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 53
Number of retired or separated participants receiving benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 53
Total participants 2022-01-01 53
2021: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 111
Number of retired or separated participants receiving benefits 2021-01-01 2
Total of all active and inactive participants 2021-01-01 113
Total participants 2021-01-01 113
2020: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 83
Number of retired or separated participants receiving benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 83
Total participants 2020-01-01 83
2019: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 151
Number of retired or separated participants receiving benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 151
Total participants 2019-01-01 151
2018: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 134
Number of retired or separated participants receiving benefits 2018-01-01 3
Total of all active and inactive participants 2018-01-01 137
Total participants 2018-01-01 137
2017: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 156
Number of retired or separated participants receiving benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 161
Total participants 2017-01-01 161
2016: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 161
Number of retired or separated participants receiving benefits 2016-01-01 2
Total of all active and inactive participants 2016-01-01 163
Total participants 2016-01-01 163
2015: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 171
Number of retired or separated participants receiving benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 173
Total participants 2015-01-01 173
2014: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 611
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 159
Number of retired or separated participants receiving benefits 2014-01-01 3
Total of all active and inactive participants 2014-01-01 162
Total participants 2014-01-01 162
2013: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 611
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 459
Total of all active and inactive participants 2013-01-01 459
Total participants 2013-01-01 459
2012: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 311
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 611
Total of all active and inactive participants 2012-01-01 611
Total participants 2012-01-01 611
2011: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 459
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 459
Total of all active and inactive participants 2011-01-01 459
Total participants 2011-01-01 459
2009: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 495
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 495
Total of all active and inactive participants 2009-01-01 495
Total participants 2009-01-01 495

Measure	Date	Value
2022: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	53
Number of retired or separated participants receiving benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	53
Total participants	2022-01-01	53
2021: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	111
Number of retired or separated participants receiving benefits	2021-01-01	2
Total of all active and inactive participants	2021-01-01	113
Total participants	2021-01-01	113
2020: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	83
Number of retired or separated participants receiving benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	83
Total participants	2020-01-01	83
2019: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	151
Number of retired or separated participants receiving benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	151
Total participants	2019-01-01	151
2018: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	134
Number of retired or separated participants receiving benefits	2018-01-01	3
Total of all active and inactive participants	2018-01-01	137
Total participants	2018-01-01	137
2017: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	156
Number of retired or separated participants receiving benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	161
Total participants	2017-01-01	161
2016: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	161
Number of retired or separated participants receiving benefits	2016-01-01	2
Total of all active and inactive participants	2016-01-01	163
Total participants	2016-01-01	163
2015: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	171
Number of retired or separated participants receiving benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	173
Total participants	2015-01-01	173
2014: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	611
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	159
Number of retired or separated participants receiving benefits	2014-01-01	3
Total of all active and inactive participants	2014-01-01	162
Total participants	2014-01-01	162
2013: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	611
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	459
Total of all active and inactive participants	2013-01-01	459
Total participants	2013-01-01	459
2012: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	311
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	611
Total of all active and inactive participants	2012-01-01	611
Total participants	2012-01-01	611
2011: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	459
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	459
Total of all active and inactive participants	2011-01-01	459
Total participants	2011-01-01	459
2009: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	495
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	495
Total of all active and inactive participants	2009-01-01	495
Total participants	2009-01-01	495

Form 5500 Responses for MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN

2022: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MULTI-CARE SERVICES HEALTH & DEPENDENT CARE 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	67
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,712
Total amount of fees paid to insurance company	USD $1,091
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,712
Amount paid for insurance broker fees	1091
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	2
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $131
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54
Amount paid for insurance broker fees	131
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	34
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,189
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $13,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	82
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,697
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Insurance broker organization code?	3

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	19
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $487
Total amount of fees paid to insurance company	USD $409
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $487
Amount paid for insurance broker fees	409
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

OH2098

Policy instance

Insurance contract or identification number	OH2098
Number of Individuals Covered	77
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $22,165
Total amount of fees paid to insurance company	USD $3,040
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $547,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,165
Amount paid for insurance broker fees	3040
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	8
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $177
Total amount of fees paid to insurance company	USD $241
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $177
Amount paid for insurance broker fees	241
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

OH2098

Policy instance

Insurance contract or identification number	OH2098
Number of Individuals Covered	96
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $35,185
Total amount of fees paid to insurance company	USD $3,210
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $881,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,185
Amount paid for insurance broker fees	3210
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	7
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $202
Total amount of fees paid to insurance company	USD $215
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $202
Amount paid for insurance broker fees	215
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	19
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,120
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $15,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79
Insurance broker organization code?	3

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	45
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,912
Total amount of fees paid to insurance company	USD $1,074
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,912
Amount paid for insurance broker fees	1074
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	35
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,730
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $30,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $168
Insurance broker organization code?	3

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	19
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $872
Total amount of fees paid to insurance company	USD $446
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $872
Amount paid for insurance broker fees	446
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	11
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $269
Total amount of fees paid to insurance company	USD $321
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $269
Amount paid for insurance broker fees	321
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

OH2098

Policy instance

Insurance contract or identification number	OH2098
Number of Individuals Covered	82
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $26,722
Total amount of fees paid to insurance company	USD $4,858
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $810,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,397
Amount paid for insurance broker fees	4183
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	37
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $698
Total amount of fees paid to insurance company	USD $30
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $324
Insurance broker organization code?	3
Amount paid for insurance broker fees	30
Additional information about fees paid to insurance broker	BONUSES

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	16
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,508
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $14,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,332
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	12
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $273
Total amount of fees paid to insurance company	USD $28
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3
Amount paid for insurance broker fees	28
Additional information about fees paid to insurance broker	BONUSES

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	10
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $248
Total amount of fees paid to insurance company	USD $19
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $130
Insurance broker organization code?	3
Amount paid for insurance broker fees	19
Additional information about fees paid to insurance broker	BONUSES

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	43
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,602
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,664
Insurance broker organization code?	3

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	68
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,832
Total amount of fees paid to insurance company	USD $86
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $950
Insurance broker organization code?	3
Amount paid for insurance broker fees	86
Additional information about fees paid to insurance broker	BONUSES

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,130
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,893
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	17
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $272
Total amount of fees paid to insurance company	USD $190
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $272
Amount paid for insurance broker fees	190
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	11
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $226
Total amount of fees paid to insurance company	USD $174
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $226
Amount paid for insurance broker fees	174
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	49
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,682
Total amount of fees paid to insurance company	USD $551
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,682
Amount paid for insurance broker fees	551
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	23
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $710
Total amount of fees paid to insurance company	USD $265
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $710
Amount paid for insurance broker fees	265
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	40
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,128
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $31,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,307
Insurance broker organization code?	3

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

Policy contract number

Policy instance

Number of Individuals Covered	77
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $36,301
Total amount of fees paid to insurance company	USD $12,687
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $728,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,301
Amount paid for insurance broker fees	12687
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	14
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,130
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61
Insurance broker organization code?	3

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )

Policy contract number

231475HNO

Policy instance

Insurance contract or identification number	231475HNO
Number of Individuals Covered	137
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $34,985
Welfare Benefit Premiums Paid to Carrier	USD $670,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,985
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	40
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,128
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $31,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,307
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	11
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $242
Total amount of fees paid to insurance company	USD $18
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $242
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	14
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $237
Total amount of fees paid to insurance company	USD $26
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $237
Amount paid for insurance broker fees	26
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	40
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,050
Total amount of fees paid to insurance company	USD $48
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,050
Amount paid for insurance broker fees	48
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	72
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,607
Total amount of fees paid to insurance company	USD $57
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,607
Amount paid for insurance broker fees	57
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	17
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $117
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $117
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	97
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,781
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $37,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,005
Insurance broker organization code?	3
Insurance broker name	WM JACK SCHOOLEY

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )

Policy contract number

231475HNO

Policy instance

Insurance contract or identification number	231475HNO
Number of Individuals Covered	154
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $34,098
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $704,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,098
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

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

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	68
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $925
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $925
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	14
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $103
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $103
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

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

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	62
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $743
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $743
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	42
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,894
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $16,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,769
Insurance broker organization code?	3
Insurance broker name	PROTEK BUSINESS MANAGMENT INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD5322

Policy instance

Insurance contract or identification number	CD5322
Number of Individuals Covered	37
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,250
Welfare Benefit Premiums Paid to Carrier	USD $19,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,250
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623777

Policy instance

Insurance contract or identification number	623777
Number of Individuals Covered	48
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $471
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $471
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	31
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,865
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,186
Insurance broker organization code?	3
Insurance broker name	PROTEK BUSINESS MANAGMENT INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	73
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,318
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,854
Insurance broker organization code?	3
Insurance broker name	BRIAN SPEAR

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

623778

Policy instance

Insurance contract or identification number	623778
Number of Individuals Covered	35
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $388
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $388
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD5321

Policy instance

Insurance contract or identification number	CD5321
Number of Individuals Covered	51
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,347
Welfare Benefit Premiums Paid to Carrier	USD $20,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,347
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

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

Policy contract number

00188666

Policy instance

Insurance contract or identification number	00188666
Number of Individuals Covered	69
Insurance policy start date	2015-09-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,493
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $212,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,493
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFIT INC

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

Policy contract number

664645

Policy instance

Insurance contract or identification number	664645
Number of Individuals Covered	59
Insurance policy start date	2014-09-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,208
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,208
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS AGENCY INC.

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CP5322

Policy instance

Insurance contract or identification number	CP5322
Number of Individuals Covered	38
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $480
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $480
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD5322

Policy instance

Insurance contract or identification number	CD5322
Number of Individuals Covered	39
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,527
Welfare Benefit Premiums Paid to Carrier	USD $17,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,527
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CP5321

Policy instance

Insurance contract or identification number	CP5321
Number of Individuals Covered	41
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $625
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $625
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	61
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,953
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,109
Insurance broker organization code?	3
Insurance broker name	BRIAN SPEAR

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

Policy contract number

00171865

Policy instance

Insurance contract or identification number	00171865
Number of Individuals Covered	95
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-30
Total amount of commissions paid to insurance broker	USD $10,982
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $219,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,982
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFIT INC

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

Policy contract number

00171864

Policy instance

Insurance contract or identification number	00171864
Number of Individuals Covered	67
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-30
Total amount of commissions paid to insurance broker	USD $9,826
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,826
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD5321

Policy instance

Insurance contract or identification number	CD5321
Number of Individuals Covered	40
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,639
Welfare Benefit Premiums Paid to Carrier	USD $20,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,639
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

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

Policy contract number

664488

Policy instance

Insurance contract or identification number	664488
Number of Individuals Covered	70
Insurance policy start date	2014-09-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,109
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,109
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS AGENCY INC.

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	31
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,224
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,259
Insurance broker organization code?	3
Insurance broker name	BRIAN SPEAR

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

Policy contract number

Policy instance

Number of Individuals Covered	49
Insurance policy start date	2013-09-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,437
Total amount of fees paid to insurance company	USD $259
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,437
Amount paid for insurance broker fees	259
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

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

Policy contract number

Policy instance

Number of Individuals Covered	43
Insurance policy start date	2013-09-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,857
Total amount of fees paid to insurance company	USD $223
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,857
Amount paid for insurance broker fees	223
Additional information about fees paid to insurance broker	FEE
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFIT INC

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

Policy contract number

00451253

Policy instance

Insurance contract or identification number	00451253
Number of Individuals Covered	459
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $7,570
Total amount of fees paid to insurance company	USD $2,977
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $50,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,570
Amount paid for insurance broker fees	2977
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	THE FEDELI GROUP INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4119

Policy instance

Insurance contract or identification number	V4119
Number of Individuals Covered	30
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,994
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,739
Insurance broker organization code?	3
Insurance broker name	BRIAN SPEAR

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

Policy contract number

027050000001

Policy instance

Insurance contract or identification number	027050000001
Number of Individuals Covered	255
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $61,344
Total amount of fees paid to insurance company	USD $20,217
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,300
Amount paid for insurance broker fees	9658
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

V4118

Policy instance

Insurance contract or identification number	V4118
Number of Individuals Covered	56
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,033
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,296
Insurance broker organization code?	3
Insurance broker name	BRIAN SPEAR

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

538461

Policy instance

Insurance contract or identification number	538461
Number of Individuals Covered	122
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,020
Total amount of fees paid to insurance company	USD $170
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,020
Amount paid for insurance broker fees	170
Additional information about fees paid to insurance broker	VOLUME INCENTIVES
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD2307,CP2307

Policy instance

Insurance contract or identification number	CD2307,CP2307
Number of Individuals Covered	129
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,265
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,265
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG693

Policy instance

Insurance contract or identification number	GG693
Number of Individuals Covered	3
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,467
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81
Insurance broker organization code?	3
Insurance broker name	LAURA HUDOCK

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG694

Policy instance

Insurance contract or identification number	GG694
Number of Individuals Covered	3
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,993
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $452
Insurance broker organization code?	3
Insurance broker name	BRITTON-GALLAGHER & ASSOC INC

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

Policy contract number

027050000001

Policy instance

Insurance contract or identification number	027050000001
Number of Individuals Covered	611
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $19,300
Total amount of fees paid to insurance company	USD $9,658
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,300
Amount paid for insurance broker fees	9658
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	ALPHA BENEFITS INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7535636

Policy instance

Insurance contract or identification number	E7535636
Number of Individuals Covered	61
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,829
Total amount of fees paid to insurance company	USD $913
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58
Amount paid for insurance broker fees	2
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT COMMUNICATIONS

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

Policy contract number

00451253

Policy instance

Insurance contract or identification number	00451253
Number of Individuals Covered	459
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $7,570
Total amount of fees paid to insurance company	USD $2,977
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $50,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,570
Amount paid for insurance broker fees	2977
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	THE FEDELI GROUP INC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MH521842

Policy instance

Insurance contract or identification number	MH521842
Number of Individuals Covered	2
Insurance policy start date	2012-01-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $52
Other welfare benefits provided	STDVOL
Welfare Benefit Premiums Paid to Carrier	USD $1,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP

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

Policy contract number

00451253

Policy instance

Insurance contract or identification number	00451253
Number of Individuals Covered	459
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $7,570
Total amount of fees paid to insurance company	USD $2,977
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $50,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

538461

Policy instance

Insurance contract or identification number	538461
Number of Individuals Covered	241
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,263
Total amount of fees paid to insurance company	USD $148
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MH521842

Policy instance

Insurance contract or identification number	MH521842
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $89
Other welfare benefits provided	STDVOL
Welfare Benefit Premiums Paid to Carrier	USD $1,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD2307,CP2307

Policy instance

Insurance contract or identification number	CD2307,CP2307
Number of Individuals Covered	256
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,055
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG694

Policy instance

Insurance contract or identification number	GG694
Number of Individuals Covered	30
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,748
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

027050000001

Policy instance

Insurance contract or identification number	027050000001
Number of Individuals Covered	255
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $81,170
Total amount of fees paid to insurance company	USD $22,298
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG693

Policy instance

Insurance contract or identification number	GG693
Number of Individuals Covered	26
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,906
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7535636

Policy instance

Insurance contract or identification number	E7535636
Number of Individuals Covered	69
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,657
Total amount of fees paid to insurance company	USD $1,181
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7535636

Policy instance

Insurance contract or identification number	E7535636
Number of Individuals Covered	76
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,390
Total amount of fees paid to insurance company	USD $1,050
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83
Amount paid for insurance broker fees	6
Insurance broker organization code?	3
Insurance broker name	MICHAEL FRANKS

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

Policy contract number

00451253

Policy instance

Insurance contract or identification number	00451253
Number of Individuals Covered	459
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $8,236
Total amount of fees paid to insurance company	USD $1,197
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $54,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,236
Amount paid for insurance broker fees	1197
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	THE FEDELI GROUP INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG694

Policy instance

Insurance contract or identification number	GG694
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,765
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $695
Insurance broker organization code?	3
Insurance broker name	GREG DEMATTEIS

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

538461

Policy instance

Insurance contract or identification number	538461
Number of Individuals Covered	211
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,813
Total amount of fees paid to insurance company	USD $197
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,813
Amount paid for insurance broker fees	197
Additional information about fees paid to insurance broker	VOLUME INCENTIVE
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

GG693

Policy instance

Insurance contract or identification number	GG693
Number of Individuals Covered	16
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,201
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $186
Insurance broker organization code?	3
Insurance broker name	GREG DEMATTEIS

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MH521842

Policy instance

Insurance contract or identification number	MH521842
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $92
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP

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

Policy contract number

027050000001

Policy instance

Insurance contract or identification number	027050000001
Number of Individuals Covered	160
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $49,287
Total amount of fees paid to insurance company	USD $31,980
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,287
Amount paid for insurance broker fees	31980
Insurance broker organization code?	3
Insurance broker name	THE FEDELI GROUP

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD2307

Policy instance

Insurance contract or identification number	CD2307
Number of Individuals Covered	207
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,667
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $287
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

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Company Name:	MULTI-CARE SERVICES, INC.
Employer identification number (EIN):	341629769
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities