401k Plan data: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN plan

HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 401k Plan overview

Plan Name	HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN
Plan identification number	502

HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: HYDRAFORCE, INC.

Employer identification number (EIN): 363524515

NAIC Classification: 332900

Additional information about HYDRAFORCE, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1999-07-01

Company Identification Number: P99000060337

Legal Registered Office Address: 7909 PROFESSIONAL PLACE

TAMPA

33637

More information about HYDRAFORCE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN

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

Plan Statistics for HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN

401k plan membership statisitcs for HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN

Measure Date Value
2022: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,675
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,710
Total of all active and inactive participants 2022-01-01 1,710
Total participants 2022-01-01 1,710
2021: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,696
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,675
Total of all active and inactive participants 2021-01-01 1,675
Total participants 2021-01-01 1,675
2020: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,815
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,696
Total of all active and inactive participants 2020-01-01 1,696
Total participants 2020-01-01 1,696
2019: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,740
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,815
Total of all active and inactive participants 2019-01-01 1,815
Total participants 2019-01-01 1,815
2018: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,561
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,740
Total of all active and inactive participants 2018-01-01 1,740
Total participants 2018-01-01 1,740
2017: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,391
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,561
Total of all active and inactive participants 2017-01-01 1,561
Total participants 2017-01-01 1,561
2016: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,381
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,391
Total of all active and inactive participants 2016-01-01 1,391
Total participants 2016-01-01 1,391
2015: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,340
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,381
Total of all active and inactive participants 2015-01-01 1,381
Total participants 2015-01-01 0
2014: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,103
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,340
Total of all active and inactive participants 2014-01-01 1,340
Total participants 2014-01-01 0
2013: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 715
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,103
Total of all active and inactive participants 2013-01-01 1,103
Total participants 2013-01-01 0
2012: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 647
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 715
Total of all active and inactive participants 2012-01-01 715
Total participants 2012-01-01 0
2011: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 539
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 647
Total of all active and inactive participants 2011-01-01 647
Total participants 2011-01-01 647
2009: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 546
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 496
Total of all active and inactive participants 2009-01-01 496
Total participants 2009-01-01 496

Measure	Date	Value
2022: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,675
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,710
Total of all active and inactive participants	2022-01-01	1,710
Total participants	2022-01-01	1,710
2021: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,696
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,675
Total of all active and inactive participants	2021-01-01	1,675
Total participants	2021-01-01	1,675
2020: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,815
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,696
Total of all active and inactive participants	2020-01-01	1,696
Total participants	2020-01-01	1,696
2019: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,740
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,815
Total of all active and inactive participants	2019-01-01	1,815
Total participants	2019-01-01	1,815
2018: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,561
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,740
Total of all active and inactive participants	2018-01-01	1,740
Total participants	2018-01-01	1,740
2017: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,391
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,561
Total of all active and inactive participants	2017-01-01	1,561
Total participants	2017-01-01	1,561
2016: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,381
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,391
Total of all active and inactive participants	2016-01-01	1,391
Total participants	2016-01-01	1,391
2015: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,340
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,381
Total of all active and inactive participants	2015-01-01	1,381
Total participants	2015-01-01	0
2014: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,103
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,340
Total of all active and inactive participants	2014-01-01	1,340
Total participants	2014-01-01	0
2013: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	715
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,103
Total of all active and inactive participants	2013-01-01	1,103
Total participants	2013-01-01	0
2012: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	647
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	715
Total of all active and inactive participants	2012-01-01	715
Total participants	2012-01-01	0
2011: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	539
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	647
Total of all active and inactive participants	2011-01-01	647
Total participants	2011-01-01	647
2009: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	546
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	496
Total of all active and inactive participants	2009-01-01	496
Total participants	2009-01-01	496

Financial Data on HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN

Measure	Date	Value
2013 : HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2013 401k financial data
Value of total assets at end of year	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	No
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No

Form 5500 Responses for HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN

2022: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2021: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2020: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2019: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2018: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2017: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2016: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 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 benefit arrangement – Insurance	Yes
2015: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: HYDRAFORCE, INC. GROUP MEDICAL, GROUP DENTAL, STD LTD, LIFE, SECTION 125 PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	73
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,989
Total amount of fees paid to insurance company	USD $195
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $19,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,825
Amount paid for insurance broker fees	195
Additional information about fees paid to insurance broker	SUPP. COMP.
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

346160

Policy instance

Insurance contract or identification number	346160
Number of Individuals Covered	1710
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $138,688
Total amount of fees paid to insurance company	USD $46,423
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,236,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138,688
Amount paid for insurance broker fees	46423
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1776
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,398
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,245
Insurance broker organization code?	3

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

Policy contract number

000010257004

Policy instance

Insurance contract or identification number	000010257004
Number of Individuals Covered	1018
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,295
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LIFE, DEPENDENT LIFE, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $166,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,295
Insurance broker organization code?	3

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

Policy contract number

000010257005

Policy instance

Insurance contract or identification number	000010257005
Number of Individuals Covered	1019
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,715
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,715
Insurance broker organization code?	3

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

Policy contract number

000010257006

Policy instance

Insurance contract or identification number	000010257006
Number of Individuals Covered	1018
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,019
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $220,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,019
Insurance broker organization code?	3

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

Policy contract number

00001D040106

Policy instance

Insurance contract or identification number	00001D040106
Number of Individuals Covered	820
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,223
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $744,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,223
Insurance broker organization code?	3

CURALINC HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02170

Policy instance

Insurance contract or identification number	02170
Number of Individuals Covered	945
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $15,305
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	395
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $27,643
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $184,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,643
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

712965

Policy instance

Insurance contract or identification number	712965
Number of Individuals Covered	644
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,590
Total amount of fees paid to insurance company	USD $1,851
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	ACC. CRITICAL ILLNESS, HOSP. CONF.
Welfare Benefit Premiums Paid to Carrier	USD $88,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,003
Insurance broker organization code?	3
Amount paid for insurance broker fees	1851
Additional information about fees paid to insurance broker	SUPPL. COMM.

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

Policy contract number

000010257004

Policy instance

Insurance contract or identification number	000010257004
Number of Individuals Covered	1525
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,828
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	DEPENDENT LIFE, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $147,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,828
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	73
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,946
Total amount of fees paid to insurance company	USD $248
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $19,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,946
Amount paid for insurance broker fees	55
Additional information about fees paid to insurance broker	NON-MONETARY COMP
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

346160

Policy instance

Insurance contract or identification number	346160
Number of Individuals Covered	1675
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,580
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,202,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,580
Insurance broker organization code?	3

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1732
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,864
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,864
Insurance broker organization code?	3

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

Policy contract number

000010257005

Policy instance

Insurance contract or identification number	000010257005
Number of Individuals Covered	901
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,683
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $144,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,683
Insurance broker organization code?	3

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

Policy contract number

000010257006

Policy instance

Insurance contract or identification number	000010257006
Number of Individuals Covered	900
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,824
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $196,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,824
Insurance broker organization code?	3

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

Policy contract number

00001D040106

Policy instance

Insurance contract or identification number	00001D040106
Number of Individuals Covered	780
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $37,938
Total amount of fees paid to insurance company	USD $3,218
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $758,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,938
Amount paid for insurance broker fees	3218
Additional information about fees paid to insurance broker	DENTAL GROWTH STRATEGY
Insurance broker organization code?	3

CURALINC HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

02170

Policy instance

Insurance contract or identification number	02170
Number of Individuals Covered	925
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $14,074
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	898
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $27,464
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $183,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,464
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

71296-5

Policy instance

Insurance contract or identification number	71296-5
Number of Individuals Covered	671
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,579
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	ACC. CRITICAL ILLNESS, HOSP. CONF.
Welfare Benefit Premiums Paid to Carrier	USD $88,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,768
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	71
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,951
Total amount of fees paid to insurance company	USD $58
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $19,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,951
Amount paid for insurance broker fees	58
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMP.
Insurance broker organization code?	3

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1754
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,355
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,355
Insurance broker organization code?	3

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

Policy contract number

5939870

Policy instance

Insurance contract or identification number	5939870
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,603
Total amount of fees paid to insurance company	USD $2,356
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $534
Amount paid for insurance broker fees	2356
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

Policy instance

Number of Individuals Covered	1696
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $145,945
Total amount of fees paid to insurance company	USD $12,660
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,160,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $145,945
Amount paid for insurance broker fees	12660
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

10030811001

Policy instance

Insurance contract or identification number	10030811001
Number of Individuals Covered	24
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $652
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

000010257004

Policy instance

Insurance contract or identification number	000010257004
Number of Individuals Covered	1529
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,041
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPENDENT LIFE, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $138,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,041
Insurance broker organization code?	3

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

Policy contract number

000010257005

Policy instance

Insurance contract or identification number	000010257005
Number of Individuals Covered	895
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,017
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,017
Insurance broker organization code?	3

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

Policy contract number

000010257006

Policy instance

Insurance contract or identification number	000010257006
Number of Individuals Covered	895
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,219
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,219
Insurance broker organization code?	3

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

Policy contract number

00001D040106

Policy instance

Insurance contract or identification number	00001D040106
Number of Individuals Covered	805
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,497
Total amount of fees paid to insurance company	USD $35,986
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $719,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,497
Amount paid for insurance broker fees	35986
Additional information about fees paid to insurance broker	DENTAL GROWTH STRATEGY
Insurance broker organization code?	3

INTEGRATED BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15168180

Policy instance

Insurance contract or identification number	15168180
Number of Individuals Covered	901
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $16,852
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	777
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,617
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $170,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,617
Insurance broker organization code?	3

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

Policy contract number

R0569772

Policy instance

Insurance contract or identification number	R0569772
Number of Individuals Covered	443
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $15,416
Total amount of fees paid to insurance company	USD $582
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	GROUP CI, GROUP ACC, GROUP HOSP
Welfare Benefit Premiums Paid to Carrier	USD $115,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,189
Insurance broker organization code?	3
Amount paid for insurance broker fees	248
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

5939870

Policy instance

Insurance contract or identification number	5939870
Number of Individuals Covered	1862
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,685
Total amount of fees paid to insurance company	USD $3,927
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $671,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,255
Amount paid for insurance broker fees	3927
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1897
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,960
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $102,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,681
Insurance broker organization code?	3

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

Policy contract number

0010391865

Policy instance

Insurance contract or identification number	0010391865
Number of Individuals Covered	314
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $11,591
Total amount of fees paid to insurance company	USD $360
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,416
Amount paid for insurance broker fees	265
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	74
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,904
Total amount of fees paid to insurance company	USD $75
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $19,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,796
Amount paid for insurance broker fees	75
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

10030811001

Policy instance

Insurance contract or identification number	10030811001
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $142
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $116
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

Policy instance

Number of Individuals Covered	1815
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $149,500
Total amount of fees paid to insurance company	USD $6,083
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,062,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $137,087
Insurance broker organization code?	3
Amount paid for insurance broker fees	6083
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	406
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $19,885
Total amount of fees paid to insurance company	USD $906
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,092
Insurance broker organization code?	3
Amount paid for insurance broker fees	906
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	1018
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $12,972
Total amount of fees paid to insurance company	USD $3,946
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $518,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,038
Amount paid for insurance broker fees	3946
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	1034
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $14,587
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $569,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,587
Insurance broker organization code?	3

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	438
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $20,164
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,164
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

Policy instance

Number of Individuals Covered	1740
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $135,677
Total amount of fees paid to insurance company	USD $4,440
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $863,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $135,677
Amount paid for insurance broker fees	4440
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

R0569772

Policy instance

Insurance contract or identification number	R0569772
Number of Individuals Covered	468
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $29,421
Total amount of fees paid to insurance company	USD $2,493
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $134,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,353
Amount paid for insurance broker fees	2493
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

5939870

Policy instance

Insurance contract or identification number	5939870
Number of Individuals Covered	1845
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $17,266
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $581,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,658
Insurance broker organization code?	3

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1900
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,671
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,671
Insurance broker organization code?	3

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

Policy contract number

0010391865

Policy instance

Insurance contract or identification number	0010391865
Number of Individuals Covered	308
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $18,803
Total amount of fees paid to insurance company	USD $1,186
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,336
Amount paid for insurance broker fees	1186
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8210010

Policy instance

Insurance contract or identification number	8210010
Number of Individuals Covered	50
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,287
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $12,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,287
Insurance broker organization code?	3

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

Policy contract number

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	798
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $13,500
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $402,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,500
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	501
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $20,704
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,704
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P46270

Policy instance

Insurance contract or identification number	P46270
Number of Individuals Covered	1561
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $114,905
Total amount of fees paid to insurance company	USD $4,440
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $653,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114,905
Amount paid for insurance broker fees	4440
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	KAMM INSURANCE GROUP

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

Policy contract number

R0569772

Policy instance

Insurance contract or identification number	R0569772
Number of Individuals Covered	412
Insurance policy start date	2016-12-31
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16,765
Total amount of fees paid to insurance company	USD $888
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $124,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,217
Amount paid for insurance broker fees	882
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MORRIS CHRISTOPHER ROBERT

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

Policy contract number

5939870

Policy instance

Insurance contract or identification number	5939870
Number of Individuals Covered	1620
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,828
Total amount of fees paid to insurance company	USD $4
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $493,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,189
Insurance broker organization code?	3
Amount paid for insurance broker fees	4
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker name	EUCLID INSURANCE SERVICES INC

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

Policy contract number

10030821001

Policy instance

Insurance contract or identification number	10030821001
Number of Individuals Covered	1685
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,004
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,004
Insurance broker organization code?	3
Insurance broker name	KAMM INSURANCE GROUP

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P46270

Policy instance

Insurance contract or identification number	P46270
Number of Individuals Covered	1381
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $110,087
Total amount of fees paid to insurance company	USD $4,620
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $552,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,087
Amount paid for insurance broker fees	4620
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	KAMM INSURANCE GROUP

PROTEC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15297 )

Policy contract number

11165

Policy instance

Insurance contract or identification number	11165
Number of Individuals Covered	664
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,064
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,064
Insurance broker organization code?	3
Insurance broker name	KAMM INSURANCE GROUP

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	331
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $15,492
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,492
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

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

Policy contract number

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	746
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $13,123
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $345,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,123
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11165

Policy instance

Insurance contract or identification number	11165
Number of Individuals Covered	649
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P46270

Policy instance

Insurance contract or identification number	P46270
Number of Individuals Covered	1340
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $105,813
Total amount of fees paid to insurance company	USD $12,844
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $571,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,636
Amount paid for insurance broker fees	12844
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	KAMM INSURANCE GROUP

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	301
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $14,222
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,222
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

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

Policy contract number

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	758
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $13,402
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $389,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,402
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

PROTEC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15297 )

Policy contract number

11165

Policy instance

Insurance contract or identification number	11165
Number of Individuals Covered	656
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,075
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,652
Insurance broker organization code?	3
Insurance broker name	MYERS, BRIGGS & CO

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11165

Policy instance

Insurance contract or identification number	11165
Number of Individuals Covered	656
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P46270

Policy instance

Insurance contract or identification number	P46270
Number of Individuals Covered	1103
Total amount of commissions paid to insurance broker	USD $92,782
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92,782
Insurance broker name	MYERS, BRIGGS & CO

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

Policy contract number

211627

Policy instance

Insurance contract or identification number	211627
Number of Individuals Covered	254
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $14,051
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,051
Insurance broker name	MYERS-BRIGGS & CO

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11165

Policy instance

Insurance contract or identification number	11165
Number of Individuals Covered	540
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,521
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

211626

Policy instance

Insurance contract or identification number	211626
Number of Individuals Covered	720
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $9,811
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $301,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,811
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

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

Policy contract number

000010106602

Policy instance

Insurance contract or identification number	000010106602
Number of Individuals Covered	715
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $38,457
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $444,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,457
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

503021461

Policy instance

Insurance contract or identification number	503021461
Number of Individuals Covered	465
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,305
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $33,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,305
Insurance broker organization code?	3
Insurance broker name	MERITAIN HEALTH

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL13696

Policy instance

Insurance contract or identification number	HCL13696
Number of Individuals Covered	464
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $20,782
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $709,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,782
Insurance broker organization code?	3
Insurance broker name	MERITAIN HEALTH

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

503021130

Policy instance

Insurance contract or identification number	503021130
Number of Individuals Covered	412
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $2,796
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $27,962
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

000010106602

Policy instance

Insurance contract or identification number	000010106602
Number of Individuals Covered	647
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $42,518
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $349,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL13696

Policy instance

Insurance contract or identification number	HCL13696
Number of Individuals Covered	434
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $21,427
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $730,892
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

000010106602

Policy instance

Insurance contract or identification number	000010106602
Number of Individuals Covered	539
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $38,026
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $270,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,026
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

503021130

Policy instance

Insurance contract or identification number	503021130
Number of Individuals Covered	391
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $2,776
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $27,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,776
Insurance broker organization code?	3
Insurance broker name	MYERS-BRIGGS & CO.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL13696

Policy instance

Insurance contract or identification number	HCL13696
Number of Individuals Covered	405
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $67,730
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $650,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,730
Insurance broker organization code?	3
Insurance broker name	MERITAIN HEALTH

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Company Name:	HYDRAFORCE, INC.
Employer identification number (EIN):	363524515
NAIC Classification:	332900

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1999-07-01
Company Identification Number:	P99000060337
Legal Registered Office Address:	7909 PROFESSIONAL PLACE TAMPA 33637