401k Plan data: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN plan

FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 401k Plan overview

Plan Name	FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN
Plan identification number	505

FIRST MERCHANTS CORPORATION 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

FIRST MERCHANTS CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: FIRST MERCHANTS CORPORATION

Employer identification number (EIN): 351544218

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about FIRST MERCHANTS CORPORATION

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 0876591

More information about FIRST MERCHANTS CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-01-01 STEVE HARRIS 2023-07-07
505 2021-01-01 STEVE HARRIS 2022-06-17
505 2020-01-01 SHAWN R. MOORE 2021-10-11
505 2019-01-01 SHAWN R. MOORE 2020-10-13
505 2018-01-01 SHAWN R. MOORE 2019-10-06 SHAWN R. MOORE 2019-10-06
505 2017-01-01
505 2016-01-01
505 2015-01-01
505 2014-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2022-01-01	STEVE HARRIS	2023-07-07
505	2021-01-01	STEVE HARRIS	2022-06-17
505	2020-01-01	SHAWN R. MOORE	2021-10-11
505	2019-01-01	SHAWN R. MOORE	2020-10-13
505	2018-01-01	SHAWN R. MOORE	2019-10-06	SHAWN R. MOORE	2019-10-06
505	2017-01-01
505	2016-01-01
505	2015-01-01
505	2014-01-01

Plan Statistics for FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN

401k plan membership statisitcs for FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN

Measure Date Value
2022: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,755
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,046
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 2,056
Number of employers contributing to the scheme 2022-01-01 0
2021: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,821
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,762
Number of retired or separated participants receiving benefits 2021-01-01 18
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 1,780
Number of employers contributing to the scheme 2021-01-01 0
2020: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,801
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,778
Number of retired or separated participants receiving benefits 2020-01-01 43
Total of all active and inactive participants 2020-01-01 1,821
Total participants 2020-01-01 1,821
2019: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,601
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,575
Number of retired or separated participants receiving benefits 2019-01-01 14
Total of all active and inactive participants 2019-01-01 1,589
Total participants 2019-01-01 1,589
2018: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,546
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,581
Number of retired or separated participants receiving benefits 2018-01-01 13
Total of all active and inactive participants 2018-01-01 1,594
Total participants 2018-01-01 1,594
2017: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,358
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,386
Number of retired or separated participants receiving benefits 2017-01-01 22
Total of all active and inactive participants 2017-01-01 1,408
Total participants 2017-01-01 1,408
2016: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,016
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 912
Number of retired or separated participants receiving benefits 2016-01-01 30
Total of all active and inactive participants 2016-01-01 942
Total participants 2016-01-01 942
2015: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 971
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 888
Number of retired or separated participants receiving benefits 2015-01-01 30
Total of all active and inactive participants 2015-01-01 918
Total participants 2015-01-01 918
2014: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,015
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 891
Number of retired or separated participants receiving benefits 2014-01-01 30
Total of all active and inactive participants 2014-01-01 921
Total participants 2014-01-01 921

Measure	Date	Value
2022: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,755
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,046
Number of retired or separated participants receiving benefits	2022-01-01	10
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	2,056
Number of employers contributing to the scheme	2022-01-01	0
2021: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,821
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,762
Number of retired or separated participants receiving benefits	2021-01-01	18
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	1,780
Number of employers contributing to the scheme	2021-01-01	0
2020: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,801
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,778
Number of retired or separated participants receiving benefits	2020-01-01	43
Total of all active and inactive participants	2020-01-01	1,821
Total participants	2020-01-01	1,821
2019: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,601
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,575
Number of retired or separated participants receiving benefits	2019-01-01	14
Total of all active and inactive participants	2019-01-01	1,589
Total participants	2019-01-01	1,589
2018: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,546
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,581
Number of retired or separated participants receiving benefits	2018-01-01	13
Total of all active and inactive participants	2018-01-01	1,594
Total participants	2018-01-01	1,594
2017: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,358
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,386
Number of retired or separated participants receiving benefits	2017-01-01	22
Total of all active and inactive participants	2017-01-01	1,408
Total participants	2017-01-01	1,408
2016: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,016
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	912
Number of retired or separated participants receiving benefits	2016-01-01	30
Total of all active and inactive participants	2016-01-01	942
Total participants	2016-01-01	942
2015: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	971
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	888
Number of retired or separated participants receiving benefits	2015-01-01	30
Total of all active and inactive participants	2015-01-01	918
Total participants	2015-01-01	918
2014: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,015
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	891
Number of retired or separated participants receiving benefits	2014-01-01	30
Total of all active and inactive participants	2014-01-01	921
Total participants	2014-01-01	921

Form 5500 Responses for FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN

2022: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
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: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
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: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
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: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
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: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: FIRST MERCHANTS CORPORATION GROUP INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

W11429

Policy instance

Insurance contract or identification number	W11429
Number of Individuals Covered	2304
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GL165016

Policy instance

Insurance contract or identification number	GL165016
Number of Individuals Covered	1755
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $75,246
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,583,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,246
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

10039698

Policy instance

Insurance contract or identification number	10039698
Number of Individuals Covered	1762
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $185,281
Total amount of fees paid to insurance company	USD $92,902
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,958,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $77,156
Amount paid for insurance broker fees	69487
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

W11429

Policy instance

Insurance contract or identification number	W11429
Number of Individuals Covered	2268
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,668
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $229,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1668
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

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	1818
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,253
Total amount of fees paid to insurance company	USD $9,614
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,253
Amount paid for insurance broker fees	9614
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

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1778
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $26,418
Total amount of fees paid to insurance company	USD $19,270
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $176,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,418
Amount paid for insurance broker fees	10464
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

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1760
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $37,230
Total amount of fees paid to insurance company	USD $24,980
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $248,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,230
Amount paid for insurance broker fees	12570
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

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	1255
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $20,885
Total amount of fees paid to insurance company	USD $46,027
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,044,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,885
Insurance broker organization code?	3
Amount paid for insurance broker fees	46027
Additional information about fees paid to insurance broker	BROKER BONUS

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	893
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $35,964
Total amount of fees paid to insurance company	USD $10,532
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $239,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,964
Insurance broker organization code?	3
Amount paid for insurance broker fees	10532
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

000404002968

Policy instance

Insurance contract or identification number	000404002968
Number of Individuals Covered	248
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,864
Total amount of fees paid to insurance company	USD $3,630
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $74,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,864
Insurance broker organization code?	3
Amount paid for insurance broker fees	3630
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

000405003744

Policy instance

Insurance contract or identification number	000405003744
Number of Individuals Covered	214
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,376
Total amount of fees paid to insurance company	USD $2,186
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $56,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,376
Insurance broker organization code?	3
Amount paid for insurance broker fees	2186
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

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1575
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $55,012
Total amount of fees paid to insurance company	USD $17,872
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,012
Insurance broker organization code?	3
Amount paid for insurance broker fees	17872
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

000404002968

Policy instance

Insurance contract or identification number	000404002968
Number of Individuals Covered	183
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,620
Total amount of fees paid to insurance company	USD $4,218
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $43,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,620
Insurance broker organization code?	3
Amount paid for insurance broker fees	4218
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

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	784
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $36,122
Total amount of fees paid to insurance company	USD $16,549
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $240,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,122
Insurance broker organization code?	3
Amount paid for insurance broker fees	16549
Additional information about fees paid to insurance broker	BROKER BONUS

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Number of Individuals Covered	2067
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $174,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1593
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $36,474
Total amount of fees paid to insurance company	USD $15,121
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $243,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,474
Insurance broker organization code?	3
Amount paid for insurance broker fees	15121
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

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	423
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $35,261
Total amount of fees paid to insurance company	USD $10,480
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $235,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,261
Insurance broker organization code?	3
Amount paid for insurance broker fees	10480
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

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	1105
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,101
Total amount of fees paid to insurance company	USD $51,329
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $855,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,101
Insurance broker organization code?	3
Amount paid for insurance broker fees	51329
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

000405003744

Policy instance

Insurance contract or identification number	000405003744
Number of Individuals Covered	191
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,728
Total amount of fees paid to insurance company	USD $3,526
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,728
Insurance broker organization code?	3
Amount paid for insurance broker fees	3526
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

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	361
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $22,472
Total amount of fees paid to insurance company	USD $6,368
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,472
Amount paid for insurance broker fees	6368
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

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1537
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $45,095
Total amount of fees paid to insurance company	USD $11,415
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,095
Amount paid for insurance broker fees	11415
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

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	1003
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $15,974
Total amount of fees paid to insurance company	USD $34,486
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $798,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,974
Amount paid for insurance broker fees	34486
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Number of Individuals Covered	2024
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,102
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $172,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,102
Insurance broker organization code?	3

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

Policy contract number

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	754
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $38,016
Total amount of fees paid to insurance company	USD $10,470
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $253,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,016
Amount paid for insurance broker fees	10470
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

000404002968

Policy instance

Insurance contract or identification number	000404002968
Number of Individuals Covered	146
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,379
Total amount of fees paid to insurance company	USD $1,964
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $44,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,379
Amount paid for insurance broker fees	1964
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

000405003744

Policy instance

Insurance contract or identification number	000405003744
Number of Individuals Covered	193
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,586
Total amount of fees paid to insurance company	USD $1,800
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $45,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,586
Amount paid for insurance broker fees	1800
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

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1583
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $34,703
Total amount of fees paid to insurance company	USD $9,627
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $231,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,703
Amount paid for insurance broker fees	9627
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

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1340
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,349
Total amount of fees paid to insurance company	USD $14,319
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $188,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,349
Amount paid for insurance broker fees	14319
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	304
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $20,417
Total amount of fees paid to insurance company	USD $7,296
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,417
Amount paid for insurance broker fees	7296
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1340
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $39,764
Total amount of fees paid to insurance company	USD $13,672
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $223,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,764
Amount paid for insurance broker fees	13672
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Number of Individuals Covered	1760
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,411
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,411
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	902
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,576
Total amount of fees paid to insurance company	USD $15,000
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $728,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,576
Amount paid for insurance broker fees	15000
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	699
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30,897
Total amount of fees paid to insurance company	USD $12,393
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $205,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,897
Amount paid for insurance broker fees	12393
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000404002968

Policy instance

Insurance contract or identification number	000404002968
Number of Individuals Covered	137
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,113
Total amount of fees paid to insurance company	USD $2,348
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $40,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,113
Amount paid for insurance broker fees	2348
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000405003744

Policy instance

Insurance contract or identification number	000405003744
Number of Individuals Covered	171
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,986
Total amount of fees paid to insurance company	USD $301
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,986
Amount paid for insurance broker fees	301
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1298
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,123
Total amount of fees paid to insurance company	USD $9,022
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $234,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,578
Amount paid for insurance broker fees	9022
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	278
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,429
Total amount of fees paid to insurance company	USD $3,913
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,795
Amount paid for insurance broker fees	3913
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1280
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $39,525
Total amount of fees paid to insurance company	USD $8,569
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $220,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,751
Amount paid for insurance broker fees	8569
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	814
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,534
Total amount of fees paid to insurance company	USD $10,000
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $676,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,036
Amount paid for insurance broker fees	10000
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Number of Individuals Covered	1588
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,915
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $118,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,600
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	701
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $28,128
Total amount of fees paid to insurance company	USD $8,162
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $187,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,735
Amount paid for insurance broker fees	8162
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000404002968

Policy instance

Insurance contract or identification number	000404002968
Number of Individuals Covered	162
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,842
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $39,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,247
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000405003744

Policy instance

Insurance contract or identification number	000405003744
Number of Individuals Covered	287
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,016
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $25,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,034
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

000010138237

Policy instance

Insurance contract or identification number	000010138237
Number of Individuals Covered	243
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,675
Total amount of fees paid to insurance company	USD $1,858
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,675
Amount paid for insurance broker fees	1858
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INC,

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

Policy contract number

000010024479

Policy instance

Insurance contract or identification number	000010024479
Number of Individuals Covered	1299
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $35,395
Total amount of fees paid to insurance company	USD $6,189
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $214,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,395
Amount paid for insurance broker fees	6189
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INC.

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

Policy contract number

00001D027156

Policy instance

Insurance contract or identification number	00001D027156
Number of Individuals Covered	824
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,606
Total amount of fees paid to insurance company	USD $3,750
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $580,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,606
Amount paid for insurance broker fees	3750
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INC

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

Policy contract number

000405003805

Policy instance

Insurance contract or identification number	000405003805
Number of Individuals Covered	349
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,745
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,745
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INS

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

Policy contract number

000404003032

Policy instance

Insurance contract or identification number	000404003032
Number of Individuals Covered	349
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,881
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $44,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,881
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INS

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

001007133

Policy instance

Insurance contract or identification number	001007133
Number of Individuals Covered	1565
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,863
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,863
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INSURANCE SERVICES

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

Policy contract number

40000100008550

Policy instance

Insurance contract or identification number	40000100008550
Number of Individuals Covered	698
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $30,607
Total amount of fees paid to insurance company	USD $7,783
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,607
Amount paid for insurance broker fees	7783
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INC.

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

Policy contract number

000010039698

Policy instance

Insurance contract or identification number	000010039698
Number of Individuals Covered	1317
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $33,832
Total amount of fees paid to insurance company	USD $8,677
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $225,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,832
Amount paid for insurance broker fees	8677
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FIRST MERCHANTS INS SVCS INC.

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FIRST MERCHANTS BANK NA 401 K PROFIT SHARING PLAN TRUST [EIN = 350508403]

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Company Name:	FIRST MERCHANTS CORPORATION
Employer identification number (EIN):	351544218
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	0876591