401k Plan data: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN plan

KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 401k Plan overview

Plan Name	KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN
Plan identification number	503

KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN Benefits

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

401k Sponsoring company profile

THE KNAPHEIDE MANUFACTURING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: THE KNAPHEIDE MANUFACTURING COMPANY

Employer identification number (EIN): 370368620

NAIC Classification: 336990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01
503 2021-01-01
503 2020-01-01
503 2019-01-01
503 2018-01-01
503 2017-01-01 ROBERT OVERHOLSER
503 2016-01-01 ROBERT OVERHOLSER
503 2015-01-01 ROBERT OVERHOLSER
503 2014-01-01 ROBERT OVERHOLSER
503 2013-01-01 ROBERT OVERHOLSER
503 2012-01-01 ROBERT OVERHOLSER
503 2011-01-01 ROBERT OVERHOLSER
503 2010-01-01 ROBERT OVERHOLSER
503 2009-01-01 ROBERT OVERHOLSER

Plan Statistics for KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN

401k plan membership statisitcs for KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN

Measure Date Value
2022: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,961
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,039
Number of retired or separated participants receiving benefits 2022-01-01 5
Number of other retired or separated participants entitled to future benefits 2022-01-01 20
Total of all active and inactive participants 2022-01-01 2,064
2021: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,008
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,924
Number of retired or separated participants receiving benefits 2021-01-01 16
Number of other retired or separated participants entitled to future benefits 2021-01-01 21
Total of all active and inactive participants 2021-01-01 1,961
2020: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,129
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,969
Number of retired or separated participants receiving benefits 2020-01-01 23
Number of other retired or separated participants entitled to future benefits 2020-01-01 16
Total of all active and inactive participants 2020-01-01 2,008
2019: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,004
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2,086
Number of retired or separated participants receiving benefits 2019-01-01 22
Number of other retired or separated participants entitled to future benefits 2019-01-01 21
Total of all active and inactive participants 2019-01-01 2,129
2018: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,795
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2,004
Number of retired or separated participants receiving benefits 2018-01-01 25
Number of other retired or separated participants entitled to future benefits 2018-01-01 12
Total of all active and inactive participants 2018-01-01 2,041
2017: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,765
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,795
Number of retired or separated participants receiving benefits 2017-01-01 28
Number of other retired or separated participants entitled to future benefits 2017-01-01 14
Total of all active and inactive participants 2017-01-01 1,837
2016: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,566
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,724
Number of retired or separated participants receiving benefits 2016-01-01 28
Number of other retired or separated participants entitled to future benefits 2016-01-01 13
Total of all active and inactive participants 2016-01-01 1,765
2015: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,372
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,566
Number of retired or separated participants receiving benefits 2015-01-01 4
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,570
2014: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,985
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,347
Number of retired or separated participants receiving benefits 2014-01-01 25
Total of all active and inactive participants 2014-01-01 1,372
Total participants 2014-01-01 0
2013: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,638
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,968
Number of retired or separated participants receiving benefits 2013-01-01 17
Total of all active and inactive participants 2013-01-01 2,985
Total participants 2013-01-01 0
2012: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,175
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,624
Number of retired or separated participants receiving benefits 2012-01-01 14
Total of all active and inactive participants 2012-01-01 2,638
Total participants 2012-01-01 0
2011: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,119
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,175
Number of retired or separated participants receiving benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 2,185
Total participants 2011-01-01 2,185
2010: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,879
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2,079
Number of retired or separated participants receiving benefits 2010-01-01 40
Total of all active and inactive participants 2010-01-01 2,119
Total participants 2010-01-01 2,119
2009: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,879
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,826
Number of retired or separated participants receiving benefits 2009-01-01 53
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 1,879

Measure	Date	Value
2022: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,961
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,039
Number of retired or separated participants receiving benefits	2022-01-01	5
Number of other retired or separated participants entitled to future benefits	2022-01-01	20
Total of all active and inactive participants	2022-01-01	2,064
2021: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,008
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,924
Number of retired or separated participants receiving benefits	2021-01-01	16
Number of other retired or separated participants entitled to future benefits	2021-01-01	21
Total of all active and inactive participants	2021-01-01	1,961
2020: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,129
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,969
Number of retired or separated participants receiving benefits	2020-01-01	23
Number of other retired or separated participants entitled to future benefits	2020-01-01	16
Total of all active and inactive participants	2020-01-01	2,008
2019: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,004
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,086
Number of retired or separated participants receiving benefits	2019-01-01	22
Number of other retired or separated participants entitled to future benefits	2019-01-01	21
Total of all active and inactive participants	2019-01-01	2,129
2018: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,795
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2,004
Number of retired or separated participants receiving benefits	2018-01-01	25
Number of other retired or separated participants entitled to future benefits	2018-01-01	12
Total of all active and inactive participants	2018-01-01	2,041
2017: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,765
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,795
Number of retired or separated participants receiving benefits	2017-01-01	28
Number of other retired or separated participants entitled to future benefits	2017-01-01	14
Total of all active and inactive participants	2017-01-01	1,837
2016: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,566
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,724
Number of retired or separated participants receiving benefits	2016-01-01	28
Number of other retired or separated participants entitled to future benefits	2016-01-01	13
Total of all active and inactive participants	2016-01-01	1,765
2015: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,372
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,566
Number of retired or separated participants receiving benefits	2015-01-01	4
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,570
2014: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,985
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,347
Number of retired or separated participants receiving benefits	2014-01-01	25
Total of all active and inactive participants	2014-01-01	1,372
Total participants	2014-01-01	0
2013: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,638
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,968
Number of retired or separated participants receiving benefits	2013-01-01	17
Total of all active and inactive participants	2013-01-01	2,985
Total participants	2013-01-01	0
2012: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,175
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,624
Number of retired or separated participants receiving benefits	2012-01-01	14
Total of all active and inactive participants	2012-01-01	2,638
Total participants	2012-01-01	0
2011: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,119
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,175
Number of retired or separated participants receiving benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	2,185
Total participants	2011-01-01	2,185
2010: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,879
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,079
Number of retired or separated participants receiving benefits	2010-01-01	40
Total of all active and inactive participants	2010-01-01	2,119
Total participants	2010-01-01	2,119
2009: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,879
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,826
Number of retired or separated participants receiving benefits	2009-01-01	53
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,879

Form 5500 Responses for KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN

2022: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING 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: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: KNAPHEIDE MFG CO GROUP HOSPITAL AND FLEXIBLE SPENDING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967891

Policy instance

Insurance contract or identification number	FLX967891
Number of Individuals Covered	487
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,775
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,775
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	1286
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,614
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 $9,614

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

Policy contract number

402866G

Policy instance

Insurance contract or identification number	402866G
Number of Individuals Covered	2058
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $40,265
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 $805,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,265
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

661675

Policy instance

Insurance contract or identification number	661675
Number of Individuals Covered	3615
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $95,229
Total amount of fees paid to insurance company	USD $24,374
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $95,229
Amount paid for insurance broker fees	24374
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	43
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $766
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $15,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $383
Insurance broker organization code?	3

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

Policy contract number

HCL36206

Policy instance

Insurance contract or identification number	HCL36206
Number of Individuals Covered	1809
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $128,025
Total amount of fees paid to insurance company	USD $64,724
Welfare Benefit Premiums Paid to Carrier	USD $1,422,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,025
Amount paid for insurance broker fees	64724
Additional information about fees paid to insurance broker	OVERRIDE PAYMENTS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK817614

Policy instance

Insurance contract or identification number	OK817614
Number of Individuals Covered	6
Insurance policy start date	2021-01-08
Insurance policy end date	2022-01-07
Total amount of commissions paid to insurance broker	USD $223
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $223

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	1232
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,484
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 $8,484

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

Policy contract number

661675

Policy instance

Insurance contract or identification number	661675
Number of Individuals Covered	3689
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $94,469
Total amount of fees paid to insurance company	USD $25,018
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $94,469
Amount paid for insurance broker fees	25018
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

402866G

Policy instance

Insurance contract or identification number	402866G
Number of Individuals Covered	2035
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $39,253
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 $785,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,253
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	45
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $706
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $13,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $353
Insurance broker organization code?	3

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

Policy contract number

HCL36206

Policy instance

Insurance contract or identification number	HCL36206
Number of Individuals Covered	1741
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $131,620
Total amount of fees paid to insurance company	USD $66,541
Welfare Benefit Premiums Paid to Carrier	USD $1,462,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $131,620
Amount paid for insurance broker fees	66541
Additional information about fees paid to insurance broker	OVERRIDE PAYMENTS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK817614

Policy instance

Insurance contract or identification number	OK817614
Number of Individuals Covered	11
Insurance policy start date	2020-08-01
Insurance policy end date	2021-08-01
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967891

Policy instance

Insurance contract or identification number	FLX967891
Number of Individuals Covered	370
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $15,386
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,386
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967891

Policy instance

Insurance contract or identification number	FLX967891
Number of Individuals Covered	385
Insurance policy start date	2020-07-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,942
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,942
Insurance broker organization code?	3

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

Policy contract number

661675

Policy instance

Insurance contract or identification number	661675
Number of Individuals Covered	3850
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $98,510
Total amount of fees paid to insurance company	USD $22,380
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,510
Amount paid for insurance broker fees	22380
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	48
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $1,058
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $21,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $529
Insurance broker organization code?	3

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

ESL-30369

Policy instance

Insurance contract or identification number	ESL-30369
Number of Individuals Covered	1792
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $230,766
Welfare Benefit Premiums Paid to Carrier	USD $1,538,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $230,766
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK817614

Policy instance

Insurance contract or identification number	OK817614
Number of Individuals Covered	20
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $184
Other welfare benefits provided	ACCIDENTAL INJURY
Welfare Benefit Premiums Paid to Carrier	USD $1,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	1231
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,189
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 $9,189

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

Policy contract number

402866G

Policy instance

Insurance contract or identification number	402866G
Number of Individuals Covered	2017
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $39,940
Total amount of fees paid to insurance company	USD $2,335
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 $798,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,940
Amount paid for insurance broker fees	2335
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK817614

Policy instance

Insurance contract or identification number	OK817614
Number of Individuals Covered	14
Insurance policy start date	2018-08-01
Insurance policy end date	2019-08-01
Total amount of commissions paid to insurance broker	USD $306
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $306

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967891

Policy instance

Insurance contract or identification number	FLX967891
Number of Individuals Covered	366
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $13,425
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,425
Insurance broker organization code?	3

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	52
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $1,056
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $15,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $528
Insurance broker organization code?	3

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

Policy contract number

661675

Policy instance

Insurance contract or identification number	661675
Number of Individuals Covered	4025
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $99,756
Total amount of fees paid to insurance company	USD $21,588
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99,756
Amount paid for insurance broker fees	21588
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

402866G

Policy instance

Insurance contract or identification number	402866G
Number of Individuals Covered	2124
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $37,908
Total amount of fees paid to insurance company	USD $2,220
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 $745,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,908
Amount paid for insurance broker fees	2220
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	1246
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,423
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 $6,423

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

ESL-30369

Policy instance

Insurance contract or identification number	ESL-30369
Number of Individuals Covered	1855
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $225,205
Welfare Benefit Premiums Paid to Carrier	USD $1,126,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $225,205
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	10
Insurance policy start date	2016-08-01
Insurance policy end date	2017-08-01
Total amount of commissions paid to insurance broker	USD $440
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $440
Insurance broker organization code?	3
Insurance broker name

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

EXL-30300

Policy instance

Insurance contract or identification number	EXL-30300
Number of Individuals Covered	1728
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $174,034
Welfare Benefit Premiums Paid to Carrier	USD $870,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $174,034
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	68
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,462
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $21,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $731
Insurance broker organization code?	3
Insurance broker name	BCINSOURCING LLC

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

Policy contract number

661675

Policy instance

Insurance contract or identification number	661675
Number of Individuals Covered	3809
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $88,952
Total amount of fees paid to insurance company	USD $19,104
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,952
Amount paid for insurance broker fees	19104
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

402866G

Policy instance

Insurance contract or identification number	402866G
Number of Individuals Covered	1822
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $38,056
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 $631,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,056
Insurance broker organization code?	3
Insurance broker name

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	1038
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,844
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 $6,844
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

0008020834

Policy instance

Insurance contract or identification number	0008020834
Number of Individuals Covered	81
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,046
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $29,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,023
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC

MCLAREN HEALTH (National Association of Insurance Commissioners NAIC id number: 95562 )

Policy contract number

101865

Policy instance

Insurance contract or identification number	101865
Number of Individuals Covered	53
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,976
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $203,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,976
Insurance broker organization code?	3
Insurance broker name	FRANKLIN BENEFIT SOLUTIONS

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

588

Policy instance

Insurance contract or identification number	588
Number of Individuals Covered	48
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,610
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,610
Insurance broker organization code?	3
Insurance broker name	MICHAEL SPLEET

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

405410 0010

Policy instance

Insurance contract or identification number	405410 0010
Number of Individuals Covered	1390
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $116,390
Welfare Benefit Premiums Paid to Carrier	USD $775,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $116,390
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

789310 S001

Policy instance

Insurance contract or identification number	789310 S001
Number of Individuals Covered	40
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,809
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $128,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,809
Insurance broker organization code?	3
Insurance broker name	MICHAEL SPLEET

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

Policy contract number

000010160716

Policy instance

Insurance contract or identification number	000010160716
Number of Individuals Covered	1727
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $22,414
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $280,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,414
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	791
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,922
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 $4,922
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	31
Insurance policy start date	2014-08-01
Insurance policy end date	2015-08-01
Total amount of commissions paid to insurance broker	USD $576
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $576
Insurance broker name	CASON HUFF & SCHLUETER INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Insurance policy start date	2015-01-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $362
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $362
Insurance broker organization code?	3
Insurance broker name	FRANKLIN BENEFIT SOLUTIONS

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

Policy contract number

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	3587
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $79,002
Total amount of fees paid to insurance company	USD $13,640
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79,002
Amount paid for insurance broker fees	13640
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

000010160714

Policy instance

Insurance contract or identification number	000010160714
Number of Individuals Covered	1684
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $23,033
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,033
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

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

Policy contract number

000010160716

Policy instance

Insurance contract or identification number	000010160716
Number of Individuals Covered	1576
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $20,174
Total amount of fees paid to insurance company	USD $6,316
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $252,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,174
Amount paid for insurance broker fees	6316
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

MCLAREN HEALTH (National Association of Insurance Commissioners NAIC id number: 95562 )

Policy contract number

101865

Policy instance

Insurance contract or identification number	101865
Number of Individuals Covered	57
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,976
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,959
Insurance broker organization code?	3
Insurance broker name	FRANKLIN BENEFIT SOLUTIONS

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

Policy contract number

102713

Policy instance

Insurance contract or identification number	102713
Number of Individuals Covered	205
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $4,129
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,129
Insurance broker organization code?	3
Insurance broker name	FAUBLE INSURANCE AGENCY INC

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

789310 S001

Policy instance

Insurance contract or identification number	789310 S001
Number of Individuals Covered	39
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,821
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,683
Insurance broker organization code?	3
Insurance broker name	SPLEET, MICHAEL

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

Policy contract number

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	3137
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $73,719
Total amount of fees paid to insurance company	USD $13,140
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,719
Amount paid for insurance broker fees	13140
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	33
Insurance policy start date	2013-08-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $558
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $558
Insurance broker organization code?	3
Insurance broker name	CASON HUFF & SCHLUETER INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	596
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,930
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 $3,930
Insurance broker organization code?	3
Insurance broker name	CASON HUFF & SCHLUETER INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Number of Individuals Covered	30
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $434
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $287
Insurance broker organization code?	3
Insurance broker name	FRANKLIN BENEFIT SOLUTIONS

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

Policy contract number

HCL19393

Policy instance

Insurance contract or identification number	HCL19393
Number of Individuals Covered	1363
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $115,113
Welfare Benefit Premiums Paid to Carrier	USD $767,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,416
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

8020834

Policy instance

Insurance contract or identification number	8020834
Number of Individuals Covered	86
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $2,188
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $31,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,094
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC

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

Policy contract number

000010160714

Policy instance

Insurance contract or identification number	000010160714
Number of Individuals Covered	1576
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $20,537
Total amount of fees paid to insurance company	USD $6,363
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $256,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,537
Amount paid for insurance broker fees	6363
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

789310 S001

Policy instance

Insurance contract or identification number	789310 S001
Number of Individuals Covered	33
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $2,893
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,893
Insurance broker organization code?	3
Insurance broker name	WIRA, MARK T

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Number of Individuals Covered	28
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	33
Insurance policy start date	2012-08-01
Insurance policy end date	2013-08-01
Total amount of commissions paid to insurance broker	USD $626
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $4,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $626
Insurance broker organization code?	3
Insurance broker name	CASON HUFF & SCHLUETER INC

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

65129

Policy instance

Insurance contract or identification number	65129
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 $2,866
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,866
Insurance broker name	PARTNERS ADVANTAGE, LLC

MCLAREN HEALTH (National Association of Insurance Commissioners NAIC id number: 95562 )

Policy contract number

101865

Policy instance

Insurance contract or identification number	101865
Number of Individuals Covered	51
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,517
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $214,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,517
Insurance broker name	MT&W ASSOCIATES

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

Policy contract number

000010160716

Policy instance

Insurance contract or identification number	000010160716
Number of Individuals Covered	1415
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $17,152
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&DM
Welfare Benefit Premiums Paid to Carrier	USD $214,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,152
Insurance broker name	GROUP BENEFITS LTD

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

Policy contract number

000010160714

Policy instance

Insurance contract or identification number	000010160714
Number of Individuals Covered	1415
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $17,650
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $220,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,650
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

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

Policy contract number

8020834

Policy instance

Insurance contract or identification number	8020834
Number of Individuals Covered	90
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $2,498
Other welfare benefits provided	ACCIDENT, CRITILLNES, ISWL STND
Welfare Benefit Premiums Paid to Carrier	USD $33,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,249
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC

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

Policy contract number

HCL19393

Policy instance

Insurance contract or identification number	HCL19393
Number of Individuals Covered	1297
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $102,029
Welfare Benefit Premiums Paid to Carrier	USD $600,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,022
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	2968
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $66,947
Total amount of fees paid to insurance company	USD $10,152
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,947
Amount paid for insurance broker fees	10152
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Number of Individuals Covered	27
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $366
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $366
Insurance broker name	MT & W ASSOCIATES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	496
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,821
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 $3,821
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	35
Insurance policy start date	2011-08-01
Insurance policy end date	2012-08-01
Total amount of commissions paid to insurance broker	USD $670
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $4,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $670
Insurance broker organization code?	3
Insurance broker name	CASON HUFF & SCHLUETER INC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00191383/0001

Policy instance

Insurance contract or identification number	00191383/0001
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,862
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $176,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,862
Insurance broker organization code?	3
Insurance broker name	MT&W ASSOCIATES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	382
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,754
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 $2,754
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Number of Individuals Covered	24
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $357
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $357
Insurance broker organization code?	3
Insurance broker name	MT&W ASSOCIATES, INC.

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

Policy contract number

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	2624
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $54,953
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,953
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

102713

Policy instance

Insurance contract or identification number	102713
Number of Individuals Covered	159
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $2,591
Life 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 $2,591
Insurance broker name	FAUBLE INSURANCE AGENCY INC

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

Policy contract number

677150G

Policy instance

Insurance contract or identification number	677150G
Number of Individuals Covered	2046
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $27,597
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $344,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,597
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

65129

Policy instance

Insurance contract or identification number	65129
Number of Individuals Covered	35
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,134
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,134
Insurance broker name	PARTNERS ADVANTAGE, LLC

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

Policy contract number

HCL19393

Policy instance

Insurance contract or identification number	HCL19393
Number of Individuals Covered	1106
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $76,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,035
Insurance broker name	LOCKTON COMPANIES LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	38
Insurance policy start date	2010-08-01
Insurance policy end date	2011-08-01
Total amount of commissions paid to insurance broker	USD $717
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $4,781
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

TM05591001

Policy instance

Insurance contract or identification number	TM05591001
Number of Individuals Covered	98
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,860
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00191383/0001

Policy instance

Insurance contract or identification number	00191383/0001
Number of Individuals Covered	59
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,106
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $227,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	283
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,194
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
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 $298
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,982
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

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	2185
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $105,383
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $349,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

677150G

Policy instance

Insurance contract or identification number	677150G
Number of Individuals Covered	1880
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $24,986
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $312,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

65129

Policy instance

Insurance contract or identification number	65129
Number of Individuals Covered	10
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $627
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

65129

Policy instance

Insurance contract or identification number	65129
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $567
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $567
Insurance broker name	PARTNERS ADVANTAGE, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 817614

Policy instance

Insurance contract or identification number	OK 817614
Number of Individuals Covered	41
Insurance policy start date	2009-08-01
Insurance policy end date	2010-08-01
Total amount of commissions paid to insurance broker	USD $824
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $824
Insurance broker organization code?	3
Insurance broker name	JACK FREIBURG INSURANCE

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

Policy contract number

TM05591001

Policy instance

Insurance contract or identification number	TM05591001
Number of Individuals Covered	88
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,823
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,823
Insurance broker organization code?	3
Insurance broker name	MT&W ASSOCIATES D/B/A ANN ARBOR FIN

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12339772

Policy instance

Insurance contract or identification number	12339772
Number of Individuals Covered	190
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,701
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 $1,701
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12267658

Policy instance

Insurance contract or identification number	12267658
Number of Individuals Covered	18
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $290
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 $290
Insurance broker organization code?	3
Insurance broker name	MT&W ASSOCIATES, INC.

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

Policy contract number

P61775

Policy instance

Insurance contract or identification number	P61775
Number of Individuals Covered	2119
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $101,299
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $303,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $101,299
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00191383/0001

Policy instance

Insurance contract or identification number	00191383/0001
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 $5,069
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,069
Insurance broker organization code?	3
Insurance broker name	MT & W ASSOCIATES, INC.

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

Policy contract number

677150G

Policy instance

Insurance contract or identification number	677150G
Number of Individuals Covered	1750
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $28,592
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $262,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,586
Insurance broker organization code?	3
Insurance broker name	GROUP BENEFITS LTD

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Company Name:	THE KNAPHEIDE MANUFACTURING COMPANY
Employer identification number (EIN):	370368620
NAIC Classification:	336990