401k Plan data: HORTON INSURANCE EMPLOYEE BENEFIT PLAN plan

HORTON INSURANCE EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	HORTON INSURANCE EMPLOYEE BENEFIT PLAN
Plan identification number	501

HORTON INSURANCE EMPLOYEE BENEFIT 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

401k Sponsoring company profile

THE HORTON GROUP, INC. & SUBS has sponsored the creation of one or more 401k plans.

Company Name: THE HORTON GROUP, INC. & SUBS

Employer identification number (EIN): 363672171

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HORTON INSURANCE EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 TRICIA PUCEK 2023-09-27
501 2021-01-01 TRICIA PUCEK 2022-10-10
501 2020-04-01
501 2019-04-01
501 2018-04-01 GEORGE DALEY
501 2017-04-01 GEORGE DALEY
501 2016-04-01 GEORGE M DALY
501 2015-04-01 GEORGE M DALY
501 2014-04-01 GEORGE M DALY
501 2013-04-01 GEORGE M DALY
501 2012-04-01 GEORGE M DALY
501 2011-04-01 GEORGE M DALY
501 2010-04-01 GEORGE M DALY
501 2009-04-01 GEORGE M DALY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	TRICIA PUCEK	2023-09-27
501	2021-01-01	TRICIA PUCEK	2022-10-10
501	2020-04-01
501	2019-04-01
501	2018-04-01	GEORGE DALEY
501	2017-04-01	GEORGE DALEY
501	2016-04-01	GEORGE M DALY
501	2015-04-01	GEORGE M DALY
501	2014-04-01	GEORGE M DALY
501	2013-04-01	GEORGE M DALY
501	2012-04-01	GEORGE M DALY
501	2011-04-01	GEORGE M DALY
501	2010-04-01	GEORGE M DALY
501	2009-04-01	GEORGE M DALY

Plan Statistics for HORTON INSURANCE EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for HORTON INSURANCE EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 387
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 379
Total of all active and inactive participants 2022-01-01 379
2021: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 387
Total of all active and inactive participants 2021-01-01 387
2020: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 352
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 363
Total of all active and inactive participants 2020-04-01 363
2019: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 352
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 352
Total of all active and inactive participants 2019-04-01 352
2018: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-04-01 369
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 352
Total of all active and inactive participants 2018-04-01 352
2017: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 334
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 369
Number of retired or separated participants receiving benefits 2017-04-01 0
Number of other retired or separated participants entitled to future benefits 2017-04-01 0
Total of all active and inactive participants 2017-04-01 369
2016: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 357
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 334
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 334
2015: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 365
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 357
Number of retired or separated participants receiving benefits 2015-04-01 0
Number of other retired or separated participants entitled to future benefits 2015-04-01 0
Total of all active and inactive participants 2015-04-01 357
2014: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 241
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 365
Number of retired or separated participants receiving benefits 2014-04-01 0
Number of other retired or separated participants entitled to future benefits 2014-04-01 0
Total of all active and inactive participants 2014-04-01 365
2013: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-04-01 247
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 241
Number of retired or separated participants receiving benefits 2013-04-01 0
Number of other retired or separated participants entitled to future benefits 2013-04-01 0
Total of all active and inactive participants 2013-04-01 241
2012: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 221
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 247
Total of all active and inactive participants 2012-04-01 247
2011: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 206
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 221
Total of all active and inactive participants 2011-04-01 221
2010: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-04-01 247
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 206
Total of all active and inactive participants 2010-04-01 206
2009: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-04-01 226
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 247
Number of retired or separated participants receiving benefits 2009-04-01 0
Number of other retired or separated participants entitled to future benefits 2009-04-01 0
Total of all active and inactive participants 2009-04-01 247

Measure	Date	Value
2022: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	387
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	379
Total of all active and inactive participants	2022-01-01	379
2021: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	387
Total of all active and inactive participants	2021-01-01	387
2020: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	352
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	363
Total of all active and inactive participants	2020-04-01	363
2019: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	352
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	352
Total of all active and inactive participants	2019-04-01	352
2018: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-04-01	369
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	352
Total of all active and inactive participants	2018-04-01	352
2017: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	334
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	369
Number of retired or separated participants receiving benefits	2017-04-01	0
Number of other retired or separated participants entitled to future benefits	2017-04-01	0
Total of all active and inactive participants	2017-04-01	369
2016: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	357
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	334
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	334
2015: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	365
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	357
Number of retired or separated participants receiving benefits	2015-04-01	0
Number of other retired or separated participants entitled to future benefits	2015-04-01	0
Total of all active and inactive participants	2015-04-01	357
2014: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	241
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	365
Number of retired or separated participants receiving benefits	2014-04-01	0
Number of other retired or separated participants entitled to future benefits	2014-04-01	0
Total of all active and inactive participants	2014-04-01	365
2013: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-04-01	247
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	241
Number of retired or separated participants receiving benefits	2013-04-01	0
Number of other retired or separated participants entitled to future benefits	2013-04-01	0
Total of all active and inactive participants	2013-04-01	241
2012: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	221
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	247
Total of all active and inactive participants	2012-04-01	247
2011: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	206
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	221
Total of all active and inactive participants	2011-04-01	221
2010: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-04-01	247
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	206
Total of all active and inactive participants	2010-04-01	206
2009: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-04-01	226
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	247
Number of retired or separated participants receiving benefits	2009-04-01	0
Number of other retired or separated participants entitled to future benefits	2009-04-01	0
Total of all active and inactive participants	2009-04-01	247

Form 5500 Responses for HORTON INSURANCE EMPLOYEE BENEFIT PLAN

2022: HORTON INSURANCE EMPLOYEE BENEFIT 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: HORTON INSURANCE EMPLOYEE BENEFIT 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: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: HORTON INSURANCE EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

00001035826

Policy instance

Insurance contract or identification number	00001035826
Number of Individuals Covered	382
Insurance policy start date	2022-01-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $2,595
Total amount of fees paid to insurance company	USD $1,150
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $17,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,595
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

5392587

Policy instance

Insurance contract or identification number	5392587
Number of Individuals Covered	655
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,634
Total amount of fees paid to insurance company	USD $40
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,634
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	40

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

Policy contract number

00532041

Policy instance

Insurance contract or identification number	00532041
Number of Individuals Covered	312
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,576
Total amount of fees paid to insurance company	USD $342
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,576
Amount paid for insurance broker fees	342
Insurance broker organization code?	3

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

Policy contract number

000010241678

Policy instance

Insurance contract or identification number	000010241678
Number of Individuals Covered	294
Insurance policy start date	2022-01-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $11,921
Total amount of fees paid to insurance company	USD $4,836
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $79,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,921
Amount paid for insurance broker fees	116
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

000010135827

Policy instance

Insurance contract or identification number	000010135827
Number of Individuals Covered	379
Insurance policy start date	2022-01-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $11,575
Total amount of fees paid to insurance company	USD $4,726
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,575
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

923639

Policy instance

Insurance contract or identification number	923639
Number of Individuals Covered	306
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 $8,033
Welfare Benefit Premiums Paid to Carrier	USD $598,882
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	8033
Insurance broker organization code?	3

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

Policy contract number

417006412626

Policy instance

Insurance contract or identification number	417006412626
Number of Individuals Covered	313
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,822
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $48,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3822
Insurance broker organization code?	3

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

Policy contract number

417005412626

Policy instance

Insurance contract or identification number	417005412626
Number of Individuals Covered	311
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $598,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10082821001

Policy instance

Insurance contract or identification number	10082821001
Number of Individuals Covered	669
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 $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

0053041

Policy instance

Insurance contract or identification number	0053041
Number of Individuals Covered	294
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,639
Total amount of fees paid to insurance company	USD $2,778
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,639
Amount paid for insurance broker fees	2778
Insurance broker organization code?	3

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

Policy contract number

000010241678

Policy instance

Insurance contract or identification number	000010241678
Number of Individuals Covered	303
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,297
Total amount of fees paid to insurance company	USD $7,246
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $128,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,297
Amount paid for insurance broker fees	913
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

00001035826

Policy instance

Insurance contract or identification number	00001035826
Number of Individuals Covered	389
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,269
Total amount of fees paid to insurance company	USD $1,610
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $28,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,269
Amount paid for insurance broker fees	204
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

000010135827

Policy instance

Insurance contract or identification number	000010135827
Number of Individuals Covered	387
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,010
Total amount of fees paid to insurance company	USD $7,132
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,010
Amount paid for insurance broker fees	895
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	252
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,536
Total amount of fees paid to insurance company	USD $5,122
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,536
Amount paid for insurance broker fees	655
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

923639

Policy instance

Insurance contract or identification number	923639
Number of Individuals Covered	288
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,240
Welfare Benefit Premiums Paid to Carrier	USD $540,321
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	3240
Additional information about fees paid to insurance broker	BONUS AMOUNT
Insurance broker organization code?	3

TOKIO MARINE (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417006412626

Policy instance

Insurance contract or identification number	417006412626
Number of Individuals Covered	291
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,619
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $44,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2619
Additional information about fees paid to insurance broker	ORGAN TRANSPLANT
Insurance broker organization code?	3

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

Policy contract number

00001035826

Policy instance

Insurance contract or identification number	00001035826
Number of Individuals Covered	363
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,083
Total amount of fees paid to insurance company	USD $1,636
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $27,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,083
Amount paid for insurance broker fees	147
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

923639

Policy instance

Insurance contract or identification number	923639
Number of Individuals Covered	273
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,094
Welfare Benefit Premiums Paid to Carrier	USD $486,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3094
Additional information about fees paid to insurance broker	BONUS AMOUNT
Insurance broker organization code?	3

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

Policy contract number

0053041

Policy instance

Insurance contract or identification number	0053041
Number of Individuals Covered	278
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,148
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,148
Insurance broker organization code?	3

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

Policy contract number

000010135827

Policy instance

Insurance contract or identification number	000010135827
Number of Individuals Covered	363
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $17,896
Total amount of fees paid to insurance company	USD $7,043
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,896
Amount paid for insurance broker fees	583
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	224
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,096
Total amount of fees paid to insurance company	USD $451
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,096
Amount paid for insurance broker fees	451
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

10082821001

Policy instance

Insurance contract or identification number	10082821001
Number of Individuals Covered	637
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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 $33,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

TOKIO MARINE (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417006412626

Policy instance

Insurance contract or identification number	417006412626
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $43,074
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

000010241678

Policy instance

Insurance contract or identification number	000010241678
Number of Individuals Covered	272
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,261
Total amount of fees paid to insurance company	USD $7,338
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $121,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,261
Amount paid for insurance broker fees	622
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

0053041

Policy instance

Insurance contract or identification number	0053041
Number of Individuals Covered	256
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,500
Total amount of fees paid to insurance company	USD $1,987
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,500
Amount paid for insurance broker fees	1987
Insurance broker organization code?	3

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

Policy contract number

000010241678

Policy instance

Insurance contract or identification number	000010241678
Number of Individuals Covered	262
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $18,278
Total amount of fees paid to insurance company	USD $7,409
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $121,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,278
Amount paid for insurance broker fees	609
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDES

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

Policy contract number

00001035826

Policy instance

Insurance contract or identification number	00001035826
Number of Individuals Covered	350
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,028
Total amount of fees paid to insurance company	USD $1,633
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $26,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,028
Amount paid for insurance broker fees	139
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

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	350
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,106
Total amount of fees paid to insurance company	USD $6,793
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,106
Amount paid for insurance broker fees	527
Insurance broker organization code?	1
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	213
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,154
Total amount of fees paid to insurance company	USD $5,302
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,154
Amount paid for insurance broker fees	447
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

10082821001

Policy instance

Insurance contract or identification number	10082821001
Number of Individuals Covered	587
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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 $30,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

41700541626

Policy instance

Insurance contract or identification number	41700541626
Number of Individuals Covered	258
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $426,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TOKIO MARINE (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417006412626

Policy instance

Insurance contract or identification number	417006412626
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $39,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0053041

Policy instance

Insurance contract or identification number	0053041
Number of Individuals Covered	272
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,644
Total amount of fees paid to insurance company	USD $1,696
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,644
Amount paid for insurance broker fees	1696
Insurance broker organization code?	3

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

Policy contract number

000400002000

Policy instance

Insurance contract or identification number	000400002000
Number of Individuals Covered	240
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,284
Total amount of fees paid to insurance company	USD $7,362
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $121,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,284
Insurance broker organization code?	3
Amount paid for insurance broker fees	4266
Additional information about fees paid to insurance broker	OVERRIDES

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

Policy contract number

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	357
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,168
Total amount of fees paid to insurance company	USD $2,125
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $27,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,168
Amount paid for insurance broker fees	598
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDES

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

Policy contract number

000010135827

Policy instance

Insurance contract or identification number	000010135827
Number of Individuals Covered	357
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $15,805
Total amount of fees paid to insurance company	USD $8,373
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,805
Amount paid for insurance broker fees	2426
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	204
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,397
Total amount of fees paid to insurance company	USD $6,840
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,397
Amount paid for insurance broker fees	1927
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

10082821001

Policy instance

Insurance contract or identification number	10082821001
Number of Individuals Covered	642
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $31,661
Total amount of fees paid to insurance company	USD $0
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 $31,661
Insurance broker organization code?	3

STHEALTH/CHARTIS (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

417002412626

Policy instance

Insurance contract or identification number	417002412626
Number of Individuals Covered	275
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $392,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

417004412626

Policy instance

Insurance contract or identification number	417004412626
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $32,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STHEALTH/CHARTIS (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

417002412626

Policy instance

Insurance contract or identification number	417002412626
Number of Individuals Covered	271
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $455,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10082821001

Policy instance

Insurance contract or identification number	10082821001
Number of Individuals Covered	629
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $25,575
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
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	201
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,449
Total amount of fees paid to insurance company	USD $6,886
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,329
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

000010135827

Policy instance

Insurance contract or identification number	000010135827
Number of Individuals Covered	369
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $18,194
Total amount of fees paid to insurance company	USD $8,431
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,293
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

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	366
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,483
Total amount of fees paid to insurance company	USD $2,115
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $29,889
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

000400002000

Policy instance

Insurance contract or identification number	000400002000
Number of Individuals Covered	234
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $23,474
Total amount of fees paid to insurance company	USD $8,680
Other welfare benefits provided	VOLUNTARY WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $156,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0053041

Policy instance

Insurance contract or identification number	0053041
Number of Individuals Covered	261
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,670
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,732
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

10135827

Policy instance

Insurance contract or identification number	10135827
Number of Individuals Covered	290
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,087
Total amount of fees paid to insurance company	USD $5,399
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,495
Amount paid for insurance broker fees	1539
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	ASSUREX AGENCY INC

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

Policy contract number

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	292
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,818
Total amount of fees paid to insurance company	USD $1,367
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $21,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,415
Amount paid for insurance broker fees	380
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	ASSUREX AGENCY INC

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

Policy contract number

000400002000

Policy instance

Insurance contract or identification number	000400002000
Number of Individuals Covered	109
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,457
Total amount of fees paid to insurance company	USD $3,447
Other welfare benefits provided	VOL WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $57,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,635
Amount paid for insurance broker fees	757
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	ASSUREX AGENCY INC

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

Policy contract number

0743173

Policy instance

Insurance contract or identification number	0743173
Number of Individuals Covered	495
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,741
Total amount of fees paid to insurance company	USD $132,292
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,618,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,741
Insurance broker organization code?	3
Amount paid for insurance broker fees	125599
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker name	THE HORTON GROUP INC

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

Policy contract number

00492739

Policy instance

Insurance contract or identification number	00492739
Number of Individuals Covered	181
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,529
Total amount of fees paid to insurance company	USD $6,416
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,289
Amount paid for insurance broker fees	6416
Insurance broker organization code?	3
Insurance broker name	THE HORTON GROUP, INC

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	160
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,240
Total amount of fees paid to insurance company	USD $4,485
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $69,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,942
Amount paid for insurance broker fees	1249
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARK S METTILLE

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

Policy contract number

0002F358

Policy instance

Insurance contract or identification number	0002F358
Number of Individuals Covered	164
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,031
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,031
Insurance broker organization code?	3
Insurance broker name	THE HORTON GROUP, INC.

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	156
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,705
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $64,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,981
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	EMPLOYER PLAN SERVICES

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

Policy contract number

10135827

Policy instance

Insurance contract or identification number	10135827
Number of Individuals Covered	273
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,796
Total amount of fees paid to insurance company	USD $2,107
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2107
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $16,796
Insurance broker name	MARK S. METTILLE

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

Policy contract number

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	273
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,168
Total amount of fees paid to insurance company	USD $610
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	534
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,168
Insurance broker name	MARK S. METTILLE

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

Policy contract number

000400002000

Policy instance

Insurance contract or identification number	000400002000
Number of Individuals Covered	104
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,137
Total amount of fees paid to insurance company	USD $1,528
Other welfare benefits provided	VOL WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $39,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1413
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $8,137
Insurance broker name	MARK S METTILLE

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

Policy contract number

0743173

Policy instance

Insurance contract or identification number	0743173
Number of Individuals Covered	273
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,776
Total amount of fees paid to insurance company	USD $129,976
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,569,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,776
Insurance broker organization code?	3
Amount paid for insurance broker fees	127524
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker name	HORTON INSURANCE AGENCY

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

Policy contract number

0743173

Policy instance

Insurance contract or identification number	0743173
Number of Individuals Covered	462
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $61,202
Total amount of fees paid to insurance company	USD $61,769
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,355,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,202
Insurance broker organization code?	3
Amount paid for insurance broker fees	57225
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker name	HORTON INSURANCE COMPANY

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	296
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,219
Total amount of fees paid to insurance company	USD $2,187
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $50,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2187
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $12,219
Insurance broker name	EMPLOYER PLAN SERVICES

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

Policy contract number

0130173

Policy instance

Insurance contract or identification number	0130173
Number of Individuals Covered	39
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $585
Other welfare benefits provided	DISABILITY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $15,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $585
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THE HORTON GROUP INC.

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

Policy contract number

000400002000

Policy instance

Insurance contract or identification number	000400002000
Number of Individuals Covered	92
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,787
Total amount of fees paid to insurance company	USD $1,693
Other welfare benefits provided	VOL WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $40,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1693
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $9,787
Insurance broker name	EMPLOYER PLAN SVCS INC.

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

Policy contract number

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	241
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,698
Total amount of fees paid to insurance company	USD $719
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	719
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,698
Insurance broker name	EMPLOYER PLAN SERVICES

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

Policy contract number

10135827

Policy instance

Insurance contract or identification number	10135827
Number of Individuals Covered	241
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,587
Total amount of fees paid to insurance company	USD $2,586
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2586
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $14,587
Insurance broker name	EMPLOYER PLAN SVCS INC

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

Policy contract number

000010135826

Policy instance

Insurance contract or identification number	000010135826
Number of Individuals Covered	247
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,845
Total amount of fees paid to insurance company	USD $535
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	535
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,845
Insurance broker name	EMPLOYER PLAN SERVICES

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	283
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,556
Total amount of fees paid to insurance company	USD $1,524
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $48,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1524
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,556
Insurance broker name	GROUP INSURANCE SERVICES, INC

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

Policy contract number

0743173

Policy instance

Insurance contract or identification number	0743173
Number of Individuals Covered	466
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $111,510
Total amount of fees paid to insurance company	USD $10,320
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,216,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $111,510
Insurance broker organization code?	3
Amount paid for insurance broker fees	10160
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	HORTON INSURANCE COMPANY

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

Policy contract number

10135827

Policy instance

Insurance contract or identification number	10135827
Number of Individuals Covered	199
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,679
Total amount of fees paid to insurance company	USD $1,820
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1820
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $7,679
Insurance broker name	EMPLOYER PLAN SVCS INC

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

Policy contract number

0130173

Policy instance

Insurance contract or identification number	0130173
Number of Individuals Covered	44
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,254
Other welfare benefits provided	DISABILITY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $16,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,254
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THE HORTON GROUP INC.

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

Policy contract number

675850

Policy instance

Insurance contract or identification number	675850
Number of Individuals Covered	134
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $52,854
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,276,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

Q0836

Policy instance

Insurance contract or identification number	Q0836
Number of Individuals Covered	69
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $19,182
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $625,097
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

579560

Policy instance

Insurance contract or identification number	579560
Number of Individuals Covered	20
Insurance policy start date	2010-09-01
Insurance policy end date	2011-09-01
Total amount of commissions paid to insurance broker	USD $4,935
Total amount of fees paid to insurance company	USD $411
Other welfare benefits provided	GROUP INDIVIDUAL LTC
Welfare Benefit Premiums Paid to Carrier	USD $33,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

M001010

Policy instance

Insurance contract or identification number	M001010
Number of Individuals Covered	61
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,037
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

E3481314

Policy instance

Insurance contract or identification number	E3481314
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,015
Total amount of fees paid to insurance company	USD $201
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,089
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

M1001010

Policy instance

Insurance contract or identification number	M1001010
Number of Individuals Covered	72
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,403
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $5,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 )

Policy contract number

Q0889

Policy instance

Insurance contract or identification number	Q0889
Number of Individuals Covered	18
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,147
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $224,898
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

M001010

Policy instance

Insurance contract or identification number	M001010
Number of Individuals Covered	147
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $443
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,770
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

M001010

Policy instance

Insurance contract or identification number	M001010
Number of Individuals Covered	120
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,133
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0130173

Policy instance

Insurance contract or identification number	0130173
Number of Individuals Covered	48
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,543
Other welfare benefits provided	DISABILITY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $17,030
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

M1001010

Policy instance

Insurance contract or identification number	M1001010
Number of Individuals Covered	50
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $249
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0130173

Policy instance

Insurance contract or identification number	0130173
Number of Individuals Covered	53
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,930
Other welfare benefits provided	DISABILITY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $19,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

BGGR099948

Policy instance

Insurance contract or identification number	BGGR099948
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,195
Total amount of fees paid to insurance company	USD $120
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

675850

Policy instance

Insurance contract or identification number	675850
Number of Individuals Covered	159
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,082
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,481
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

579560

Policy instance

Insurance contract or identification number	579560
Number of Individuals Covered	20
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,614
Total amount of fees paid to insurance company	USD $385
Other welfare benefits provided	GROUP INDIVIDUAL LTC
Welfare Benefit Premiums Paid to Carrier	USD $30,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

675850

Policy instance

Insurance contract or identification number	675850
Number of Individuals Covered	91
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $49,914
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,024,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

Q0836

Policy instance

Insurance contract or identification number	Q0836
Number of Individuals Covered	70
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $25,308
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $519,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 )

Policy contract number

Q0889

Policy instance

Insurance contract or identification number	Q0889
Number of Individuals Covered	14
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,097
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

M001010

Policy instance

Insurance contract or identification number	M001010
Number of Individuals Covered	72
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $1,839
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,363
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

4000002000 2590

Policy instance

Insurance contract or identification number	4000002000 2590
Number of Individuals Covered	98
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,315
Other welfare benefits provided	VOLUNTARY WI
Welfare Benefit Premiums Paid to Carrier	USD $37,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

E3481314

Policy instance

Insurance contract or identification number	E3481314
Number of Individuals Covered	17
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,613
Total amount of fees paid to insurance company	USD $998
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	THE HORTON GROUP, INC. & SUBS
Employer identification number (EIN):	363672171
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages