401k Plan data: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION plan

BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 401k Plan overview

Plan Name	BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION
Plan identification number	501

BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BENESCH FRIEDLANDER COPLAN & ARONOFF LLP has sponsored the creation of one or more 401k plans.

Company Name: BENESCH FRIEDLANDER COPLAN & ARONOFF LLP

Employer identification number (EIN): 346596918

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01
501 2019-07-01
501 2018-07-01
501 2017-07-01
501 2016-07-01 JOHN H. BANKS
501 2015-07-01 JOHN H. BANKS
501 2014-07-01 JOHN H. BANKS
501 2013-07-01 JOHN H. BANKS
501 2012-07-01 JOHN H. BANKS
501 2011-07-01 JOHN H. BANKS
501 2010-07-01 JOHN H. BANKS
501 2009-07-01 JOHN H. BANKS

Plan Statistics for BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION

401k plan membership statisitcs for BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION

Measure Date Value
2021: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2021 401k membership
Total participants, beginning-of-year 2021-07-01 336
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 373
Number of retired or separated participants receiving benefits 2021-07-01 1
Total of all active and inactive participants 2021-07-01 374
2019: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2019 401k membership
Total participants, beginning-of-year 2019-07-01 303
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 276
Number of retired or separated participants receiving benefits 2019-07-01 1
Total of all active and inactive participants 2019-07-01 277
Total participants 2019-07-01 277
2018: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2018 401k membership
Total participants, beginning-of-year 2018-07-01 366
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 302
Number of retired or separated participants receiving benefits 2018-07-01 8
Total of all active and inactive participants 2018-07-01 310
2017: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2017 401k membership
Total participants, beginning-of-year 2017-07-01 473
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 366
Number of retired or separated participants receiving benefits 2017-07-01 13
Total of all active and inactive participants 2017-07-01 379
2016: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2016 401k membership
Total participants, beginning-of-year 2016-07-01 396
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 469
Number of retired or separated participants receiving benefits 2016-07-01 4
Total of all active and inactive participants 2016-07-01 473
2015: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2015 401k membership
Total participants, beginning-of-year 2015-07-01 363
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 392
Number of retired or separated participants receiving benefits 2015-07-01 4
Total of all active and inactive participants 2015-07-01 396
2014: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2014 401k membership
Total participants, beginning-of-year 2014-07-01 376
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 346
Number of retired or separated participants receiving benefits 2014-07-01 17
Total of all active and inactive participants 2014-07-01 363
2013: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2013 401k membership
Total participants, beginning-of-year 2013-07-01 311
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 373
Number of other retired or separated participants entitled to future benefits 2013-07-01 3
Total of all active and inactive participants 2013-07-01 376
2012: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2012 401k membership
Total participants, beginning-of-year 2012-07-01 317
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 307
Number of other retired or separated participants entitled to future benefits 2012-07-01 4
Total of all active and inactive participants 2012-07-01 311
2011: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2011 401k membership
Total participants, beginning-of-year 2011-07-01 318
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 311
Number of other retired or separated participants entitled to future benefits 2011-07-01 6
Total of all active and inactive participants 2011-07-01 317
2010: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2010 401k membership
Total participants, beginning-of-year 2010-07-01 328
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 312
Number of other retired or separated participants entitled to future benefits 2010-07-01 6
Total of all active and inactive participants 2010-07-01 318
2009: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2009 401k membership
Total participants, beginning-of-year 2009-07-01 269
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 309
Number of other retired or separated participants entitled to future benefits 2009-07-01 19
Total of all active and inactive participants 2009-07-01 328

Measure	Date	Value
2021: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2021 401k membership
Total participants, beginning-of-year	2021-07-01	336
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	373
Number of retired or separated participants receiving benefits	2021-07-01	1
Total of all active and inactive participants	2021-07-01	374
2019: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2019 401k membership
Total participants, beginning-of-year	2019-07-01	303
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	276
Number of retired or separated participants receiving benefits	2019-07-01	1
Total of all active and inactive participants	2019-07-01	277
Total participants	2019-07-01	277
2018: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2018 401k membership
Total participants, beginning-of-year	2018-07-01	366
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	302
Number of retired or separated participants receiving benefits	2018-07-01	8
Total of all active and inactive participants	2018-07-01	310
2017: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2017 401k membership
Total participants, beginning-of-year	2017-07-01	473
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	366
Number of retired or separated participants receiving benefits	2017-07-01	13
Total of all active and inactive participants	2017-07-01	379
2016: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2016 401k membership
Total participants, beginning-of-year	2016-07-01	396
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	469
Number of retired or separated participants receiving benefits	2016-07-01	4
Total of all active and inactive participants	2016-07-01	473
2015: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2015 401k membership
Total participants, beginning-of-year	2015-07-01	363
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	392
Number of retired or separated participants receiving benefits	2015-07-01	4
Total of all active and inactive participants	2015-07-01	396
2014: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2014 401k membership
Total participants, beginning-of-year	2014-07-01	376
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	346
Number of retired or separated participants receiving benefits	2014-07-01	17
Total of all active and inactive participants	2014-07-01	363
2013: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2013 401k membership
Total participants, beginning-of-year	2013-07-01	311
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	373
Number of other retired or separated participants entitled to future benefits	2013-07-01	3
Total of all active and inactive participants	2013-07-01	376
2012: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2012 401k membership
Total participants, beginning-of-year	2012-07-01	317
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	307
Number of other retired or separated participants entitled to future benefits	2012-07-01	4
Total of all active and inactive participants	2012-07-01	311
2011: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2011 401k membership
Total participants, beginning-of-year	2011-07-01	318
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	311
Number of other retired or separated participants entitled to future benefits	2011-07-01	6
Total of all active and inactive participants	2011-07-01	317
2010: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2010 401k membership
Total participants, beginning-of-year	2010-07-01	328
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	312
Number of other retired or separated participants entitled to future benefits	2010-07-01	6
Total of all active and inactive participants	2010-07-01	318
2009: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2009 401k membership
Total participants, beginning-of-year	2009-07-01	269
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	309
Number of other retired or separated participants entitled to future benefits	2009-07-01	19
Total of all active and inactive participants	2009-07-01	328

Form 5500 Responses for BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION

2021: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2019: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: BENESCH, FRIEDLANDER, COPLAN & ARONOFF LLP, GROUP TERM LIFE, DENTAL, LT DISABILITY & HOSPITALIZATION 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	532
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $15,507
Total amount of fees paid to insurance company	USD $8,725
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $152,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,487
Amount paid for insurance broker fees	8725
Insurance broker organization code?	3

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

Policy contract number

10212921001

Policy instance

Insurance contract or identification number	10212921001
Number of Individuals Covered	21
Insurance policy start date	2021-01-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $155
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $155
Insurance broker organization code?	3

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	496
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $8,888
Total amount of fees paid to insurance company	USD $7,546
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $348,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,888
Insurance broker organization code?	3
Amount paid for insurance broker fees	7546
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

0000143239

Policy instance

Insurance contract or identification number	0000143239
Number of Individuals Covered	5
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $535
Total amount of fees paid to insurance company	USD $153
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $428
Amount paid for insurance broker fees	153
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0000143238

Policy instance

Insurance contract or identification number	0000143238
Number of Individuals Covered	64
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $253
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $224,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	212
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

G9002

Policy instance

Insurance contract or identification number	G9002
Number of Individuals Covered	70
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,221
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $337,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,221
Insurance broker organization code?	3

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

Policy contract number

0000164058

Policy instance

Insurance contract or identification number	0000164058
Number of Individuals Covered	18
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,543
Total amount of fees paid to insurance company	USD $1,571
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,964
Amount paid for insurance broker fees	1571
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

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

Policy contract number

0000164056

Policy instance

Insurance contract or identification number	0000164056
Number of Individuals Covered	75
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $181
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	117
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0217007

Policy instance

Insurance contract or identification number	0217007
Number of Individuals Covered	655
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,141
Total amount of fees paid to insurance company	USD $818
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,141
Amount paid for insurance broker fees	175
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

5953342

Policy instance

Insurance contract or identification number	5953342
Number of Individuals Covered	721
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,507
Total amount of fees paid to insurance company	USD $9,458
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $295,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,505
Amount paid for insurance broker fees	486
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

OH2655

Policy instance

Insurance contract or identification number	OH2655
Number of Individuals Covered	373
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $-19,342
Total amount of fees paid to insurance company	USD $7,268
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,247,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-19,342
Amount paid for insurance broker fees	7268
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

10187951001

Policy instance

Insurance contract or identification number	10187951001
Number of Individuals Covered	599
Insurance policy start date	2021-01-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $3,732
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,732
Insurance broker organization code?	3

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

Policy contract number

0471095HNO

Policy instance

Insurance contract or identification number	0471095HNO
Number of Individuals Covered	553
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $3,865,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	381
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,651
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $247,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4651
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0471095

Policy instance

Insurance contract or identification number	0471095
Number of Individuals Covered	465
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $7,418
Total amount of fees paid to insurance company	USD $7,925
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $437,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,418
Amount paid for insurance broker fees	7925
Additional information about fees paid to insurance broker	2017 PPP ENGAGEMENT CREDIT MEDICAL RETENTION
Insurance broker organization code?	3

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	293
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $9,777
Total amount of fees paid to insurance company	USD $6,215
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,777
Amount paid for insurance broker fees	6215
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	198
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $830
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $830
Insurance broker organization code?	3

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

Policy contract number

0000143239

Policy instance

Insurance contract or identification number	0000143239
Number of Individuals Covered	8
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $952
Total amount of fees paid to insurance company	USD $676
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $688
Amount paid for insurance broker fees	300
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0000143238

Policy instance

Insurance contract or identification number	0000143238
Number of Individuals Covered	107
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $54,976
Total amount of fees paid to insurance company	USD $43,949
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,367
Amount paid for insurance broker fees	26359
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

G9002

Policy instance

Insurance contract or identification number	G9002
Number of Individuals Covered	65
Insurance policy start date	2018-07-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,997
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,390
Insurance broker organization code?	3

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	291
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $9,485
Total amount of fees paid to insurance company	USD $4,123
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	187
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $3,415
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0471095HNO

Policy instance

Insurance contract or identification number	0471095HNO
Number of Individuals Covered	518
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $3,595,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0471095

Policy instance

Insurance contract or identification number	0471095
Number of Individuals Covered	475
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $6,975
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $549,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	356
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $3,550
Total amount of fees paid to insurance company	USD $4,886
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $212,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0000143238

Policy instance

Insurance contract or identification number	0000143238
Number of Individuals Covered	107
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $54,976
Total amount of fees paid to insurance company	USD $43,949
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0000143239

Policy instance

Insurance contract or identification number	0000143239
Number of Individuals Covered	8
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $952
Total amount of fees paid to insurance company	USD $676
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,302
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

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	8
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $1,089
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $32,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,089
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

471095HNO

Policy instance

Insurance contract or identification number	471095HNO
Number of Individuals Covered	396
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $2,251,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	301
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $23,172
Total amount of fees paid to insurance company	USD $4,634
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $272,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,172
Amount paid for insurance broker fees	4634
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	TBG WEST INSURANCE SERVICES

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

Policy contract number

0000143239

Policy instance

Insurance contract or identification number	0000143239
Number of Individuals Covered	8
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $614
Total amount of fees paid to insurance company	USD $245
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $614
Amount paid for insurance broker fees	245
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	PECK, RANDALL, WARREN

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

Policy contract number

0000143238

Policy instance

Insurance contract or identification number	0000143238
Number of Individuals Covered	94
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,324
Total amount of fees paid to insurance company	USD $1,114
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,221
Amount paid for insurance broker fees	909
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	TBG WEST INSURANCE SERVICES

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	275
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $10,329
Total amount of fees paid to insurance company	USD $5,294
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,329
Amount paid for insurance broker fees	5294
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	154
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $2,815
Total amount of fees paid to insurance company	USD $241
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,815
Insurance broker organization code?	3
Amount paid for insurance broker fees	241
Additional information about fees paid to insurance broker	INCENTIVES
Insurance broker name	WILLIS INSURANCE SERIVES OF GA

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0471095

Policy instance

Insurance contract or identification number	0471095
Number of Individuals Covered	382
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $13,984
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $412,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,984
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

23789

Policy instance

Insurance contract or identification number	23789
Number of Individuals Covered	50
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $3,187
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,911
Insurance broker organization code?	3
Insurance broker name	WILIS INSURANCE SERVICES OF CA INC

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

Policy contract number

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	8
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $1,270
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $42,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,270
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0471095

Policy instance

Insurance contract or identification number	0471095
Number of Individuals Covered	346
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $5,636
Total amount of fees paid to insurance company	USD $8,224
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $480,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,636
Amount paid for insurance broker fees	8224
Additional information about fees paid to insurance broker	2013/14 MM P3 BONUS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

471095HNO

Policy instance

Insurance contract or identification number	471095HNO
Number of Individuals Covered	363
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $1,941,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

23789

Policy instance

Insurance contract or identification number	23789
Number of Individuals Covered	47
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $3,338
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,901
Insurance broker organization code?	3
Insurance broker name	WILLIS INSURANCE SERVICES OF CA

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	137
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $2,120
Total amount of fees paid to insurance company	USD $203
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,120
Insurance broker organization code?	3
Amount paid for insurance broker fees	203
Additional information about fees paid to insurance broker	VOLUME INCENTIVE
Insurance broker name	WILLIS INSURANCE SERVICES OF GA INC

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	271
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $18,752
Total amount of fees paid to insurance company	USD $2,552
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,752
Amount paid for insurance broker fees	2552
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	TBG WEST INSURANCE SERVICE

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	274
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $10,326
Total amount of fees paid to insurance company	USD $5,300
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,326
Insurance broker organization code?	3
Amount paid for insurance broker fees	5300
Additional information about fees paid to insurance broker	INCENTIVE
Insurance broker name	WILLIS INS SVCS OF CA

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

Policy contract number

0000143238

Policy instance

Insurance contract or identification number	0000143238
Number of Individuals Covered	85
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,191
Total amount of fees paid to insurance company	USD $912
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,153
Amount paid for insurance broker fees	750
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

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

Policy contract number

0000143239

Policy instance

Insurance contract or identification number	0000143239
Number of Individuals Covered	9
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $469
Total amount of fees paid to insurance company	USD $152
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $469
Amount paid for insurance broker fees	152
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PECK, RANDALL, WARREN

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

Policy contract number

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	10
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $1,403
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,403
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC.

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

Policy contract number

00481071

Policy instance

Insurance contract or identification number	00481071
Number of Individuals Covered	300
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $10,109
Total amount of fees paid to insurance company	USD $1,038
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,109
Amount paid for insurance broker fees	1038
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC.

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	153
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $2,990
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,990
Insurance broker organization code?	3
Insurance broker name	WILLIS INSURANCE SERVICES OF GA INC

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	277
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $6,145
Total amount of fees paid to insurance company	USD $1,982
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $233,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,145
Amount paid for insurance broker fees	1609
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	FREDERICK HOWARTH III

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

471095

Policy instance

Insurance contract or identification number	471095
Number of Individuals Covered	376
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $5,551
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $533,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,551
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC.

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

Policy contract number

143239

Policy instance

Insurance contract or identification number	143239
Number of Individuals Covered	15
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $699
Total amount of fees paid to insurance company	USD $202
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $699
Amount paid for insurance broker fees	202
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	RANDALL PECK

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

Policy contract number

143238

Policy instance

Insurance contract or identification number	143238
Number of Individuals Covered	86
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,560
Total amount of fees paid to insurance company	USD $952
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,560
Amount paid for insurance broker fees	751
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	DETRUDE & COMPANY INC.

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

471095-HNO

Policy instance

Insurance contract or identification number	471095-HNO
Number of Individuals Covered	371
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $1,946,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00036097

Policy instance

Insurance contract or identification number	G 00036097
Number of Individuals Covered	50
Insurance policy start date	2013-07-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $1,419
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,419
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC.

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	142
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,445
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,273
Insurance broker organization code?	3
Insurance broker name	WILLIS INSURANCE SERVICES OF GA INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

471095

Policy instance

Insurance contract or identification number	471095
Number of Individuals Covered	370
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $17,738
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $554,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,402
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

143239

Policy instance

Insurance contract or identification number	143239
Number of Individuals Covered	16
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $982
Total amount of fees paid to insurance company	USD $314
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $982
Amount paid for insurance broker fees	314
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	RANDALL PECK

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

Policy contract number

143238

Policy instance

Insurance contract or identification number	143238
Number of Individuals Covered	85
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,435
Total amount of fees paid to insurance company	USD $1,149
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,435
Insurance broker name	SHEPHERD INSURANCE AGENCY INC

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

US394209

Policy instance

Insurance contract or identification number	US394209
Number of Individuals Covered	392
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $57,933
Welfare Benefit Premiums Paid to Carrier	USD $2,004,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,185
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	299
Insurance policy start date	2012-07-01
Insurance policy end date	2013-07-01
Total amount of commissions paid to insurance broker	USD $6,382
Total amount of fees paid to insurance company	USD $1,786
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,382
Amount paid for insurance broker fees	1786
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PECK, RANDALL W

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

Policy contract number

368402G

Policy instance

Insurance contract or identification number	368402G
Number of Individuals Covered	311
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $452
Total amount of fees paid to insurance company	USD $317
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	317
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $452
Insurance broker name	WILLIS OF OHIO INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00036097

Policy instance

Insurance contract or identification number	G 00036097
Number of Individuals Covered	54
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,166
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,166
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC.

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

Policy contract number

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	12
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,740
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,740
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO, INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00036097

Policy instance

Insurance contract or identification number	G 00036097
Number of Individuals Covered	58
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $3,491
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

83126978

Policy instance

Insurance contract or identification number	83126978
Number of Individuals Covered	317
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $5,113
Total amount of fees paid to insurance company	USD $1,509
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $152,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	314
Insurance policy start date	2011-07-01
Insurance policy end date	2012-07-01
Total amount of commissions paid to insurance broker	USD $6,408
Total amount of fees paid to insurance company	USD $2,405
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $240,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

US394209

Policy instance

Insurance contract or identification number	US394209
Number of Individuals Covered	218
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $54,458
Welfare Benefit Premiums Paid to Carrier	USD $1,709,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143238

Policy instance

Insurance contract or identification number	143238
Number of Individuals Covered	84
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $1,517
Total amount of fees paid to insurance company	USD $2,016
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

471095

Policy instance

Insurance contract or identification number	471095
Number of Individuals Covered	174
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $23,252
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $493,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

567736

Policy instance

Insurance contract or identification number	567736
Number of Individuals Covered	123
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $1,872
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,451
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

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	12
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $1,613
Total amount of fees paid to insurance company	USD $5
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143239

Policy instance

Insurance contract or identification number	143239
Number of Individuals Covered	16
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $1,107
Total amount of fees paid to insurance company	USD $273
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

471095

Policy instance

Insurance contract or identification number	471095
Number of Individuals Covered	167
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $1,125
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143239

Policy instance

Insurance contract or identification number	143239
Number of Individuals Covered	20
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,481
Total amount of fees paid to insurance company	USD $318
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 96518 )

Policy contract number

US394209

Policy instance

Insurance contract or identification number	US394209
Number of Individuals Covered	223
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $58,702
Welfare Benefit Premiums Paid to Carrier	USD $1,977,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143238

Policy instance

Insurance contract or identification number	143238
Number of Individuals Covered	79
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,370
Total amount of fees paid to insurance company	USD $903
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

221118

Policy instance

Insurance contract or identification number	221118
Number of Individuals Covered	316
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $6,371
Total amount of fees paid to insurance company	USD $2,964
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $237,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

368402G

Policy instance

Insurance contract or identification number	368402G
Number of Individuals Covered	318
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $8,032
Total amount of fees paid to insurance company	USD $913
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00036097

Policy instance

Insurance contract or identification number	G 00036097
Number of Individuals Covered	58
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $3,423
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,895
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

3979

Policy instance

Insurance contract or identification number	3979
Number of Individuals Covered	15
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $1,972
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BENESCH FRIEDLANDER COPLAN & ARONOFF LLP
Employer identification number (EIN):	346596918
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers