401k Plan data: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN plan

DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 401k Plan overview

Plan Name	DMD MANAGEMENT, INC. GROUP INSURANCE PLAN
Plan identification number	502

DMD MANAGEMENT, INC. GROUP INSURANCE PLAN Benefits

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

401k Sponsoring company profile

DMD MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name: DMD MANAGEMENT, INC.

Employer identification number (EIN): 341663174

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

Additional information about DMD MANAGEMENT, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1990-11-13

Company Identification Number: 784182

Legal Registered Office Address: 12380 PLAZA DRIVE
-
PARMA
United States of America (USA)
44130

More information about DMD MANAGEMENT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DMD MANAGEMENT, INC. GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01
502 2017-01-01 BARRY STUMP
502 2016-01-01 BARRY STUMP
502 2015-01-01 BARRY STUMP
502 2014-01-01 BARRY STUMP
502 2013-01-01 BARRY STUMP
502 2012-01-01 BARRY STUMP
502 2011-01-01 BARRY STUMP
502 2010-01-01 BARRY STUMP
502 2009-01-01 BARRY STUMP

Plan Statistics for DMD MANAGEMENT, INC. GROUP INSURANCE PLAN

401k plan membership statisitcs for DMD MANAGEMENT, INC. GROUP INSURANCE PLAN

Measure Date Value
2022: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,195
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 577
Number of retired or separated participants receiving benefits 2022-01-01 10
Total of all active and inactive participants 2022-01-01 587
Total participants 2022-01-01 587
2021: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 819
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 946
Number of retired or separated participants receiving benefits 2021-01-01 3
Total of all active and inactive participants 2021-01-01 949
Total participants 2021-01-01 949
2020: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 802
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 808
Number of retired or separated participants receiving benefits 2020-01-01 11
Total of all active and inactive participants 2020-01-01 819
Total participants 2020-01-01 819
2019: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 975
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 797
Number of retired or separated participants receiving benefits 2019-01-01 5
Total of all active and inactive participants 2019-01-01 802
Total participants 2019-01-01 802
2018: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,116
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 719
Number of retired or separated participants receiving benefits 2018-01-01 16
Total of all active and inactive participants 2018-01-01 735
Total participants 2018-01-01 735
2017: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,062
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,110
Number of retired or separated participants receiving benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 1,116
Total participants 2017-01-01 1,116
2016: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,147
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,051
Number of retired or separated participants receiving benefits 2016-01-01 11
Total of all active and inactive participants 2016-01-01 1,062
Total participants 2016-01-01 1,062
2015: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,147
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,133
Number of retired or separated participants receiving benefits 2015-01-01 14
Total of all active and inactive participants 2015-01-01 1,147
Total participants 2015-01-01 1,147
2014: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,729
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,734
Number of retired or separated participants receiving benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 1,741
Total participants 2014-01-01 1,741
2013: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,729
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,720
Number of retired or separated participants receiving benefits 2013-01-01 9
Total of all active and inactive participants 2013-01-01 1,729
Total participants 2013-01-01 1,729
2012: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,390
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,716
Number of retired or separated participants receiving benefits 2012-01-01 13
Total of all active and inactive participants 2012-01-01 1,729
Total participants 2012-01-01 1,729
2011: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,412
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,371
Number of retired or separated participants receiving benefits 2011-01-01 19
Total of all active and inactive participants 2011-01-01 1,390
Total participants 2011-01-01 1,390
2010: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,501
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,412
Total of all active and inactive participants 2010-01-01 1,412
Total participants 2010-01-01 1,412
2009: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,378
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,501
Total of all active and inactive participants 2009-01-01 1,501
Total participants 2009-01-01 1,501

Measure	Date	Value
2022: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,195
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	577
Number of retired or separated participants receiving benefits	2022-01-01	10
Total of all active and inactive participants	2022-01-01	587
Total participants	2022-01-01	587
2021: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	819
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	946
Number of retired or separated participants receiving benefits	2021-01-01	3
Total of all active and inactive participants	2021-01-01	949
Total participants	2021-01-01	949
2020: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	802
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	808
Number of retired or separated participants receiving benefits	2020-01-01	11
Total of all active and inactive participants	2020-01-01	819
Total participants	2020-01-01	819
2019: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	975
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	797
Number of retired or separated participants receiving benefits	2019-01-01	5
Total of all active and inactive participants	2019-01-01	802
Total participants	2019-01-01	802
2018: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,116
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	719
Number of retired or separated participants receiving benefits	2018-01-01	16
Total of all active and inactive participants	2018-01-01	735
Total participants	2018-01-01	735
2017: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,062
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,110
Number of retired or separated participants receiving benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	1,116
Total participants	2017-01-01	1,116
2016: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,147
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,051
Number of retired or separated participants receiving benefits	2016-01-01	11
Total of all active and inactive participants	2016-01-01	1,062
Total participants	2016-01-01	1,062
2015: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,147
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,133
Number of retired or separated participants receiving benefits	2015-01-01	14
Total of all active and inactive participants	2015-01-01	1,147
Total participants	2015-01-01	1,147
2014: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,729
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,734
Number of retired or separated participants receiving benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	1,741
Total participants	2014-01-01	1,741
2013: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,729
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,720
Number of retired or separated participants receiving benefits	2013-01-01	9
Total of all active and inactive participants	2013-01-01	1,729
Total participants	2013-01-01	1,729
2012: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,390
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,716
Number of retired or separated participants receiving benefits	2012-01-01	13
Total of all active and inactive participants	2012-01-01	1,729
Total participants	2012-01-01	1,729
2011: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,412
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,371
Number of retired or separated participants receiving benefits	2011-01-01	19
Total of all active and inactive participants	2011-01-01	1,390
Total participants	2011-01-01	1,390
2010: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,501
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,412
Total of all active and inactive participants	2010-01-01	1,412
Total participants	2010-01-01	1,412
2009: DMD MANAGEMENT, INC. GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,378
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,501
Total of all active and inactive participants	2009-01-01	1,501
Total participants	2009-01-01	1,501

Form 5500 Responses for DMD MANAGEMENT, INC. GROUP INSURANCE PLAN

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

Insurance Providers Used on plan

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	893
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,637
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 $3,637
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

947664

Policy instance

Insurance contract or identification number	947664
Number of Individuals Covered	1511
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $39,208
Total amount of fees paid to insurance company	USD $11,207
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $338,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,208
Amount paid for insurance broker fees	11207
Additional information about fees paid to insurance broker	BROKER BONUSES
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	534
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $51,568
Total amount of fees paid to insurance company	USD $9,138
Health 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 $51,568
Amount paid for insurance broker fees	9138
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001

Policy instance

Insurance contract or identification number	10089801001
Number of Individuals Covered	685
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,804
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,804
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220788

Policy instance

Insurance contract or identification number	000010220788
Number of Individuals Covered	50
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,734
Total amount of fees paid to insurance company	USD $1,862
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,734
Amount paid for insurance broker fees	1862
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000404003477

Policy instance

Insurance contract or identification number	000404003477
Number of Individuals Covered	97
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,631
Total amount of fees paid to insurance company	USD $241
Other welfare benefits provided	ACC
Welfare Benefit Premiums Paid to Carrier	USD $26,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $525
Amount paid for insurance broker fees	241
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100014131

Policy instance

Insurance contract or identification number	40000100014131
Number of Individuals Covered	158
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,425
Total amount of fees paid to insurance company	USD $1,950
Other welfare benefits provided	VOL CHILD+SPOUSE LIFE, VOL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $56,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,425
Amount paid for insurance broker fees	1950
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	898
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,528
Total amount of fees paid to insurance company	USD $285
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 $3,528
Amount paid for insurance broker fees	285
Additional information about fees paid to insurance broker	RETENTION BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150137

Policy instance

Insurance contract or identification number	10150137
Number of Individuals Covered	744
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,230
Total amount of fees paid to insurance company	USD $5,742
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $160,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,230
Amount paid for insurance broker fees	5742
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	565
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $54,571
Total amount of fees paid to insurance company	USD $8,538
Health 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 $54,571
Amount paid for insurance broker fees	8538
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150136

Policy instance

Insurance contract or identification number	10150136
Number of Individuals Covered	949
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,250
Total amount of fees paid to insurance company	USD $859
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $25,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,250
Amount paid for insurance broker fees	859
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000405004229

Policy instance

Insurance contract or identification number	000405004229
Number of Individuals Covered	46
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,758
Total amount of fees paid to insurance company	USD $132
Other welfare benefits provided	CANCER INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $15,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,007
Insurance broker organization code?	3
Amount paid for insurance broker fees	132
Additional information about fees paid to insurance broker	BROKER BONUS

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001

Policy instance

Insurance contract or identification number	10089801001
Number of Individuals Covered	667
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,223
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,223
Insurance broker organization code?	3

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	900
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,580
Total amount of fees paid to insurance company	USD $388
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 $3,580
Amount paid for insurance broker fees	388
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001

Policy instance

Insurance contract or identification number	10089801001
Number of Individuals Covered	733
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,926
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,926
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000405004229

Policy instance

Insurance contract or identification number	000405004229
Number of Individuals Covered	58
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,693
Total amount of fees paid to insurance company	USD $59
Other welfare benefits provided	CANCER INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $18,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,955
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	59

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220788

Policy instance

Insurance contract or identification number	000010220788
Number of Individuals Covered	64
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,458
Total amount of fees paid to insurance company	USD $773
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,458
Amount paid for insurance broker fees	773
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100014131

Policy instance

Insurance contract or identification number	40000100014131
Number of Individuals Covered	179
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,001
Total amount of fees paid to insurance company	USD $753
Other welfare benefits provided	VOL CHILD+SPOUSE LIFE, VOL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $60,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,001
Amount paid for insurance broker fees	753
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	583
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $56,318
Total amount of fees paid to insurance company	USD $8,574
Health 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 $56,318
Amount paid for insurance broker fees	8574
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000404003477

Policy instance

Insurance contract or identification number	000404003477
Number of Individuals Covered	135
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,384
Total amount of fees paid to insurance company	USD $124
Other welfare benefits provided	ACC
Welfare Benefit Premiums Paid to Carrier	USD $36,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,075
Amount paid for insurance broker fees	124
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150137

Policy instance

Insurance contract or identification number	10150137
Number of Individuals Covered	819
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,414
Total amount of fees paid to insurance company	USD $1,972
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $176,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,414
Amount paid for insurance broker fees	1972
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150136

Policy instance

Insurance contract or identification number	10150136
Number of Individuals Covered	1082
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,394
Total amount of fees paid to insurance company	USD $229
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,394
Amount paid for insurance broker fees	229
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	916
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,558
Total amount of fees paid to insurance company	USD $85
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 $3,558
Amount paid for insurance broker fees	85
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150137

Policy instance

Insurance contract or identification number	10150137
Number of Individuals Covered	697
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,975
Total amount of fees paid to insurance company	USD $669
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $131,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,975
Amount paid for insurance broker fees	669
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

00302254

Policy instance

Insurance contract or identification number	00302254
Number of Individuals Covered	117
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,820
Total amount of fees paid to insurance company	USD $1,158
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,242
Amount paid for insurance broker fees	1158
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001

Policy instance

Insurance contract or identification number	10089801001
Number of Individuals Covered	723
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,387
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,387
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100014131

Policy instance

Insurance contract or identification number	40000100014131
Number of Individuals Covered	160
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,530
Total amount of fees paid to insurance company	USD $177
Other welfare benefits provided	VOL CHILD+SPOUSE LIFE, VOL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $50,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,530
Amount paid for insurance broker fees	177
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220788

Policy instance

Insurance contract or identification number	000010220788
Number of Individuals Covered	74
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,300
Total amount of fees paid to insurance company	USD $493
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,300
Amount paid for insurance broker fees	493
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000404003477

Policy instance

Insurance contract or identification number	000404003477
Number of Individuals Covered	159
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,812
Total amount of fees paid to insurance company	USD $563
Other welfare benefits provided	ACC
Welfare Benefit Premiums Paid to Carrier	USD $44,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $559
Amount paid for insurance broker fees	69
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	618
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $59,522
Total amount of fees paid to insurance company	USD $9,107
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $262,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,522
Amount paid for insurance broker fees	9107
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150136

Policy instance

Insurance contract or identification number	10150136
Number of Individuals Covered	566
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,580
Total amount of fees paid to insurance company	USD $132
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,580
Amount paid for insurance broker fees	132
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000405004229

Policy instance

Insurance contract or identification number	000405004229
Number of Individuals Covered	60
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,836
Total amount of fees paid to insurance company	USD $271
Other welfare benefits provided	CANCER INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $21,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,270
Amount paid for insurance broker fees	237
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220788

Policy instance

Insurance contract or identification number	000010220788
Number of Individuals Covered	129
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $19,704
Total amount of fees paid to insurance company	USD $2,102
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,704
Insurance broker organization code?	3
Amount paid for insurance broker fees	2102
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1016
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,793
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 $3,793
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000404003477

Policy instance

Insurance contract or identification number	000404003477
Number of Individuals Covered	222
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,523
Other welfare benefits provided	ACC
Welfare Benefit Premiums Paid to Carrier	USD $65,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,503
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001

Policy instance

Insurance contract or identification number	10089801001
Number of Individuals Covered	735
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,503
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,503
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150137

Policy instance

Insurance contract or identification number	10150137
Number of Individuals Covered	720
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,033
Total amount of fees paid to insurance company	USD $3,109
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $133,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,033
Insurance broker organization code?	3
Amount paid for insurance broker fees	3109
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	696
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $67,379
Total amount of fees paid to insurance company	USD $7,251
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $278,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,379
Amount paid for insurance broker fees	7251
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150136

Policy instance

Insurance contract or identification number	10150136
Number of Individuals Covered	596
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,346
Total amount of fees paid to insurance company	USD $614
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,346
Insurance broker organization code?	3
Amount paid for insurance broker fees	614
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	166
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,312
Total amount of fees paid to insurance company	USD $898
Other welfare benefits provided	VOL CHILD+SPOUSE LIFE, VOL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $35,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,312
Insurance broker organization code?	3
Amount paid for insurance broker fees	898
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000405004229

Policy instance

Insurance contract or identification number	000405004229
Number of Individuals Covered	84
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,751
Other welfare benefits provided	CANCER INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $31,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,602
Insurance broker organization code?	3

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	719
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $69,488
Total amount of fees paid to insurance company	USD $7,925
Health 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 $69,488
Amount paid for insurance broker fees	7925
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10150136

Policy instance

Insurance contract or identification number	10150136
Number of Individuals Covered	904
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,208
Total amount of fees paid to insurance company	USD $926
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $20,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,208
Insurance broker organization code?	3
Amount paid for insurance broker fees	926
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1116
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,917
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 $3,917
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10089801001-14

Policy instance

Insurance contract or identification number	10089801001-14
Number of Individuals Covered	798
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,926
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,926
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	117
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,490
Total amount of fees paid to insurance company	USD $2,569
Other welfare benefits provided	VOL CHILD+SPOUSE LIFE, VOL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $29,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,490
Insurance broker organization code?	3
Amount paid for insurance broker fees	2569
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	GALLAGHER BENEFIT SERVICE INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	8
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $134
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3
Insurance broker name	PLANCORP/VANTAGE BENEFIT ADVISORS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220788

Policy instance

Insurance contract or identification number	000010220788
Number of Individuals Covered	285
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,014
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,014
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000405004229

Policy instance

Insurance contract or identification number	000405004229
Number of Individuals Covered	127
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $25,651
Other welfare benefits provided	CANCER INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $36,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,521
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFITS SERVICES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000404003477

Policy instance

Insurance contract or identification number	000404003477
Number of Individuals Covered	320
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $49,334
Other welfare benefits provided	ACC
Welfare Benefit Premiums Paid to Carrier	USD $75,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,879
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ILLINOIS

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	63
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,747
Welfare Benefit Premiums Paid to Carrier	USD $375,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,747
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	69
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,035
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,035
Insurance broker organization code?	3
Insurance broker name	STRUCTURED BENEFITS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	10
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $154
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $154
Insurance broker organization code?	3
Insurance broker name	PLANCORP/VANTAGE BENEFIT ADVISORS

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,427
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 $4,427
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

LG034

Policy instance

Insurance contract or identification number	LG034
Number of Individuals Covered	33
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,397
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,368
Insurance broker organization code?	3
Insurance broker name	ANDREW LEVITT

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010150137

Policy instance

Insurance contract or identification number	000010150137
Number of Individuals Covered	759
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,690
Total amount of fees paid to insurance company	USD $1,782
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $201,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,690
Insurance broker organization code?	3
Amount paid for insurance broker fees	1782
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	GALLAGHER BENEFITS SERVICES

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	645
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $62,371
Total amount of fees paid to insurance company	USD $4,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,371
Amount paid for insurance broker fees	4463
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

E7242969

Policy instance

Insurance contract or identification number	E7242969
Number of Individuals Covered	59
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $9,478
Total amount of fees paid to insurance company	USD $630
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,297
Amount paid for insurance broker fees	58
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	INTEGRATED EMPLOYEE BENEFIT SOLUTIO

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	11
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $152
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	152
Insurance broker organization code?	3
Insurance broker name	PLANCORP/VANTAGE BENEFIT ADVISORS

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	71
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,171
Welfare Benefit Premiums Paid to Carrier	USD $353,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,171
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	671
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $64,778
Total amount of fees paid to insurance company	USD $41
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,778
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1147
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,427
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 $4,427
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010150137

Policy instance

Insurance contract or identification number	000010150137
Number of Individuals Covered	1741
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,981
Total amount of fees paid to insurance company	USD $6,141
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $237,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,981
Insurance broker organization code?	3
Amount paid for insurance broker fees	6141
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	GALLAGHER BENEFITS SERVICES

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

Policy contract number

E7242969

Policy instance

Insurance contract or identification number	E7242969
Number of Individuals Covered	60
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $8,854
Total amount of fees paid to insurance company	USD $195
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $993
Amount paid for insurance broker fees	50
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	DAVID L SMELCER

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

Policy contract number

0000010268

Policy instance

Insurance contract or identification number	0000010268
Number of Individuals Covered	54
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,497
Total amount of fees paid to insurance company	USD $21
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,573
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	21
Insurance broker name	ASHLEY L GRASER

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

Policy contract number

GG192

Policy instance

Insurance contract or identification number	GG192
Number of Individuals Covered	64
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,718
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,462
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
Insurance broker name	JAMES FERNANDEZ

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	73
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $935
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $935
Insurance broker organization code?	3
Insurance broker name	STRUCTURED BENEFITS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	11
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $135
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $135
Insurance broker organization code?	3
Insurance broker name	VANTAGE FINANCIAL GROUP INC

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1225
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,418
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 $4,418
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	80
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,382
Welfare Benefit Premiums Paid to Carrier	USD $393,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,382
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	79
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,092
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,092
Insurance broker organization code?	3
Insurance broker name	STRUCTURED BENEFITS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010150137

Policy instance

Insurance contract or identification number	000010150137
Number of Individuals Covered	1729
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,042
Total amount of fees paid to insurance company	USD $6,756
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $188,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,042
Insurance broker organization code?	3
Amount paid for insurance broker fees	6756
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	GALLAGHER BENEFITS SERVICES

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	658
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $63,523
Total amount of fees paid to insurance company	USD $64
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,523
Amount paid for insurance broker fees	64
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

GG192

Policy instance

Insurance contract or identification number	GG192
Number of Individuals Covered	2
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $53
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $442
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
Insurance broker name	HOWARD B LABOW

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

Policy contract number

0000010268

Policy instance

Insurance contract or identification number	0000010268
Number of Individuals Covered	54
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,411
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $368
Insurance broker organization code?	3
Insurance broker name	ASHLEY L GRASER

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010150137

Policy instance

Insurance contract or identification number	000010150137
Number of Individuals Covered	1729
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $16,164
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,467
Insurance broker organization code?	3
Insurance broker name	CGI VOLUNTARY BENEFITS INC

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	116
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $31,706
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,047
Insurance broker organization code?	3
Insurance broker name	CHRISTINE DEBRA THWING

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

Policy contract number

0000010268

Policy instance

Insurance contract or identification number	0000010268
Number of Individuals Covered	54
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $18,580
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,436
Insurance broker organization code?	3
Insurance broker name	OHIO NORTHEAST

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

Policy contract number

524292

Policy instance

Insurance contract or identification number	524292
Number of Individuals Covered	700
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $67,588
Total amount of fees paid to insurance company	USD $93
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,588
Amount paid for insurance broker fees	93
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

0119594

Policy instance

Insurance contract or identification number	0119594
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $792
Total amount of fees paid to insurance company	USD $469
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $792
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	5
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $51
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51
Insurance broker organization code?	3
Insurance broker name	HOWARD B LABOW

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	69
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $908
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $908
Insurance broker organization code?	3
Insurance broker name	STRUCTURED BENEFITS, LLC

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

Policy contract number

E7242969

Policy instance

Insurance contract or identification number	E7242969
Number of Individuals Covered	58
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $9,036
Total amount of fees paid to insurance company	USD $197
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,064
Amount paid for insurance broker fees	104
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	DAVID SMELCER

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	11
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $63
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63
Insurance broker organization code?	3
Insurance broker name	VANTAGE FINANCIAL GROUP INC

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1302
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,467
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,467
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	92
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,957
Welfare Benefit Premiums Paid to Carrier	USD $438,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,957
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

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

Policy contract number

559528

Policy instance

Insurance contract or identification number	559528
Number of Individuals Covered	758
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $73,231
Total amount of fees paid to insurance company	USD $74
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	14
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $150
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,498
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

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	36
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,389
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	85
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,977
Total amount of fees paid to insurance company	USD $100
Welfare Benefit Premiums Paid to Carrier	USD $593,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	76
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1390
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,691
Dental Insurance Welfare Benefit	Yes
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

7510100-7725831

Policy instance

Insurance contract or identification number	7510100-7725831
Number of Individuals Covered	268
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $41,005
Total amount of fees paid to insurance company	USD $5,648
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $194,826
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

0119594

Policy instance

Insurance contract or identification number	0119594
Number of Individuals Covered	933
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,375
Total amount of fees paid to insurance company	USD $2,442
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $182,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

7434

Policy instance

Insurance contract or identification number	7434
Number of Individuals Covered	1412
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,598
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 $4,598
Insurance broker organization code?	3
Insurance broker name	HERBRUCK ALDER & CO.

KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )

Policy contract number

2141

Policy instance

Insurance contract or identification number	2141
Number of Individuals Covered	109
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $13,288
Total amount of fees paid to insurance company	USD $475
Welfare Benefit Premiums Paid to Carrier	USD $661,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,288
Amount paid for insurance broker fees	475
Additional information about fees paid to insurance broker	GIFTS
Insurance broker organization code?	3
Insurance broker name	HERBRUCK ALDER & CO.

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

Policy contract number

0119594

Policy instance

Insurance contract or identification number	0119594
Number of Individuals Covered	931
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,220
Total amount of fees paid to insurance company	USD $3,529
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $184,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,220
Amount paid for insurance broker fees	3529
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HERBRUCK ADLER & CO.

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

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	44
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,901
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 $23,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,766
Insurance broker organization code?	3
Insurance broker name	BRUCE LEON

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4028193

Policy instance

Insurance contract or identification number	G# 4028193
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $142
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $1,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $142
Insurance broker organization code?	3
Insurance broker name	VANTAGE FINANCIAL GROUP INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777947

Policy instance

Insurance contract or identification number	9777947
Number of Individuals Covered	60
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $666
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $666
Insurance broker organization code?	3
Insurance broker name	STRUCTURED BENEFITS, LLC

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

Policy contract number

7510100-7725831

Policy instance

Insurance contract or identification number	7510100-7725831
Number of Individuals Covered	340
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $49,408
Total amount of fees paid to insurance company	USD $2,795
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $259,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,185
Amount paid for insurance broker fees	2147
Insurance broker organization code?	3
Insurance broker name	BARRETT BENEFITS GROUP INC

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

Policy contract number

559528

Policy instance

Insurance contract or identification number	559528
Number of Individuals Covered	774
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $74,736
Total amount of fees paid to insurance company	USD $1,960
Health 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 $74,736
Amount paid for insurance broker fees	1958
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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Company Name:	DMD MANAGEMENT, INC.
Employer identification number (EIN):	341663174
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1990-11-13
Company Identification Number:	784182
Legal Registered Office Address:	12380 PLAZA DRIVE - PARMA United States of America (USA) 44130