401k Plan data: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN plan

DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN
Plan identification number	501

DICKINSON WRIGHT PLLC MASTER WELFARE 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

DICKINSON WRIGHT PLLC MASTER WELFARE BEN has sponsored the creation of one or more 401k plans.

Company Name: DICKINSON WRIGHT PLLC MASTER WELFARE BEN

Employer identification number (EIN): 381364333

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Additional information about DICKINSON WRIGHT PLLC MASTER WELFARE BEN

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 1998-01-01

Company Identification Number: B17482

Legal Registered Office Address: 2600 W BIG BEAVER RD STE 300

TROY
United States of America (USA)
48084

More information about DICKINSON WRIGHT PLLC MASTER WELFARE BEN

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 DEBORAH L. GRACE 2023-09-27
501 2021-01-01 DEBORAH L. GRACE 2022-08-03
501 2020-01-01 DEBORAH L. GRACE 2021-09-07
501 2019-01-01 DEBORAH L. GRACE 2020-09-30
501 2018-01-01 DEBORAH L. GRACE 2019-10-08
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 DEBORAH L. GRACE
501 2011-01-01 DEBORAH L. GRACE
501 2009-01-01 DEBORAH L. GRACE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	DEBORAH L. GRACE	2023-09-27
501	2021-01-01	DEBORAH L. GRACE	2022-08-03
501	2020-01-01	DEBORAH L. GRACE	2021-09-07
501	2019-01-01	DEBORAH L. GRACE	2020-09-30
501	2018-01-01	DEBORAH L. GRACE	2019-10-08
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	DEBORAH L. GRACE
501	2011-01-01	DEBORAH L. GRACE
501	2009-01-01	DEBORAH L. GRACE

Plan Statistics for DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN

401k plan membership statisitcs for DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN

Measure Date Value
2022: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 830
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 837
Total of all active and inactive participants 2022-01-01 837
2021: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 840
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 830
Total of all active and inactive participants 2021-01-01 830
2020: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 842
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 840
Total of all active and inactive participants 2020-01-01 840
2019: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 873
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 842
Total of all active and inactive participants 2019-01-01 842
2018: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 785
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 873
Total of all active and inactive participants 2018-01-01 873
2017: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 756
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 785
Total of all active and inactive participants 2017-01-01 785
2016: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 734
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 756
Total of all active and inactive participants 2016-01-01 756
2015: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 742
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 734
Total of all active and inactive participants 2015-01-01 734
2014: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 684
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 742
Total of all active and inactive participants 2014-01-01 742
2013: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 534
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 684
Total of all active and inactive participants 2013-01-01 684
2012: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 484
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 517
Number of retired or separated participants receiving benefits 2012-01-01 5
Number of other retired or separated participants entitled to future benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 534
2011: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 475
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 484
Total of all active and inactive participants 2011-01-01 484
2009: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 370
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 359
Number of retired or separated participants receiving benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 368

Measure	Date	Value
2022: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	830
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	837
Total of all active and inactive participants	2022-01-01	837
2021: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	840
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	830
Total of all active and inactive participants	2021-01-01	830
2020: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	842
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	840
Total of all active and inactive participants	2020-01-01	840
2019: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	873
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	842
Total of all active and inactive participants	2019-01-01	842
2018: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	785
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	873
Total of all active and inactive participants	2018-01-01	873
2017: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	756
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	785
Total of all active and inactive participants	2017-01-01	785
2016: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	734
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	756
Total of all active and inactive participants	2016-01-01	756
2015: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	742
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	734
Total of all active and inactive participants	2015-01-01	734
2014: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	684
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	742
Total of all active and inactive participants	2014-01-01	742
2013: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	534
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	684
Total of all active and inactive participants	2013-01-01	684
2012: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	484
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	517
Number of retired or separated participants receiving benefits	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	534
2011: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	475
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	484
Total of all active and inactive participants	2011-01-01	484
2009: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	359
Number of retired or separated participants receiving benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	368

Form 5500 Responses for DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN

2022: DICKINSON WRIGHT PLLC MASTER WELFARE 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: DICKINSON WRIGHT PLLC MASTER WELFARE 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: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: DICKINSON WRIGHT PLLC MASTER WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

9906-1559

Policy instance

Insurance contract or identification number	9906-1559
Number of Individuals Covered	837
Insurance policy start date	2021-11-01
Insurance policy end date	2022-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $35
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	CONTINGENT COMMISSION
Insurance broker organization code?	3

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	294
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $55,778
Total amount of fees paid to insurance company	USD $5,312
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $265,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,571
Amount paid for insurance broker fees	2657
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

573367-0001

Policy instance

Insurance contract or identification number	573367-0001
Number of Individuals Covered	55
Insurance policy start date	2022-02-01
Insurance policy end date	2023-02-01
Total amount of commissions paid to insurance broker	USD $25,880
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $157,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,721
Insurance broker organization code?	3

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

Policy contract number

30020592

Policy instance

Insurance contract or identification number	30020592
Number of Individuals Covered	868
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	4

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	780
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $177,457
Total amount of fees paid to insurance company	USD $29,568
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,478,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,051
Amount paid for insurance broker fees	15208
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	525
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,145
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,145
Insurance broker organization code?	3

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	740
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $162,867
Total amount of fees paid to insurance company	USD $27,141
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,357,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $149,610
Amount paid for insurance broker fees	27141
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

573367-0001

Policy instance

Insurance contract or identification number	573367-0001
Number of Individuals Covered	17
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $10,068
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $73,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,509
Insurance broker organization code?	3

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	278
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $53,478
Total amount of fees paid to insurance company	USD $5,097
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $254,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,974
Amount paid for insurance broker fees	5097
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

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

Policy contract number

9906-1559

Policy instance

Insurance contract or identification number	9906-1559
Number of Individuals Covered	830
Insurance policy start date	2020-11-01
Insurance policy end date	2021-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Insurance broker organization code?	3

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

Policy contract number

9906-1559

Policy instance

Insurance contract or identification number	9906-1559
Number of Individuals Covered	840
Insurance policy start date	2019-11-01
Insurance policy end date	2020-11-01
Total amount of commissions paid to insurance broker	USD $497
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $497
Insurance broker organization code?	3

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	523
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,178
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,178
Insurance broker organization code?	3

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	732
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $153,631
Total amount of fees paid to insurance company	USD $28,586
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,294,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $153,631
Amount paid for insurance broker fees	28586
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

573367-0001

Policy instance

Insurance contract or identification number	573367-0001
Number of Individuals Covered	20
Insurance policy start date	2020-02-01
Insurance policy end date	2021-02-01
Total amount of commissions paid to insurance broker	USD $9,352
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $62,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,676
Insurance broker organization code?	3

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	281
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $49,171
Total amount of fees paid to insurance company	USD $4,917
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $245,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,171
Amount paid for insurance broker fees	4917
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	57
Insurance policy start date	2019-02-01
Insurance policy end date	2020-02-01
Total amount of commissions paid to insurance broker	USD $18,288
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $112,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,647
Insurance broker organization code?	3

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	537
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,098
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,098
Insurance broker organization code?	3

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	775
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $134,961
Total amount of fees paid to insurance company	USD $32,024
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,764,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,013
Amount paid for insurance broker fees	20688
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

6475-62-60

Policy instance

Insurance contract or identification number	6475-62-60
Number of Individuals Covered	842
Insurance policy start date	2018-11-01
Insurance policy end date	2019-11-01
Total amount of commissions paid to insurance broker	USD $497
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $497
Insurance broker organization code?	3

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	266
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $30,566
Total amount of fees paid to insurance company	USD $2,944
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $203,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,642
Amount paid for insurance broker fees	1887
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	534
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,129
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,129
Insurance broker organization code?	3

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	787
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $121,511
Total amount of fees paid to insurance company	USD $28,563
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,478,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,743
Amount paid for insurance broker fees	27217
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	266
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $37,697
Total amount of fees paid to insurance company	USD $3,141
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $232,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,697
Amount paid for insurance broker fees	3141
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

6475-62-60

Policy instance

Insurance contract or identification number	6475-62-60
Number of Individuals Covered	873
Insurance policy start date	2017-11-01
Insurance policy end date	2018-11-01
Total amount of commissions paid to insurance broker	USD $497
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $497
Insurance broker organization code?	3

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	11
Insurance policy start date	2018-02-01
Insurance policy end date	2019-02-01
Total amount of commissions paid to insurance broker	USD $16,639
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $117,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,639
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

7262

Policy instance

Insurance contract or identification number	7262
Number of Individuals Covered	1350
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,814
Total amount of fees paid to insurance company	USD $0
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 $10,814
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	785
Insurance policy start date	2016-11-01
Insurance policy end date	2017-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $133
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Amount paid for insurance broker fees	133
Additional information about fees paid to insurance broker	GUARUNTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	OSWALD COMPANIES

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	490
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,053
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,053
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	12
Insurance policy start date	2017-02-01
Insurance policy end date	2018-02-01
Total amount of commissions paid to insurance broker	USD $27,260
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $180,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,260
Insurance broker organization code?	3
Insurance broker name	THE UFER GROUP

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	255
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $29,680
Total amount of fees paid to insurance company	USD $2,473
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $216,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,680
Amount paid for insurance broker fees	2473
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILSHIRE BENEFITS GROUP, INC.

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	742
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $123,402
Total amount of fees paid to insurance company	USD $28,967
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,489,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $112,524
Amount paid for insurance broker fees	27607
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILSHIRE BENEFITS GROUP, INC.

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

7262

Policy instance

Insurance contract or identification number	7262
Number of Individuals Covered	1225
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $16,761
Total amount of fees paid to insurance company	USD $0
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 $16,761
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	734
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	637
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $94,407
Total amount of fees paid to insurance company	USD $20,500
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,218,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,170
Amount paid for insurance broker fees	19882
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	38
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $27,389
Total amount of fees paid to insurance company	USD $3,195
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $183,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,389
Amount paid for insurance broker fees	3195
Insurance broker organization code?	3
Insurance broker name	THE UFER GROUP

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	213
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $27,171
Total amount of fees paid to insurance company	USD $1,359
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $181,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,171
Amount paid for insurance broker fees	1359
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	410
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,823
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,823
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

7262

Policy instance

Insurance contract or identification number	7262
Number of Individuals Covered	1092
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,269
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $16,269
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	41
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $27,263
Total amount of fees paid to insurance company	USD $3,318
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $185,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,263
Amount paid for insurance broker fees	3318
Insurance broker organization code?	3
Insurance broker name	THE UFER GROUP

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	199
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $29,255
Total amount of fees paid to insurance company	USD $1,463
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $181,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,255
Amount paid for insurance broker fees	1463
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	742
Insurance policy start date	2013-11-01
Insurance policy end date	2014-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $31
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Amount paid for insurance broker fees	31
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	348
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,671
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,671
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	590
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $96,320
Total amount of fees paid to insurance company	USD $22,611
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,247,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,832
Amount paid for insurance broker fees	21974
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	194
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $24,335
Total amount of fees paid to insurance company	USD $1,409
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $175,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,335
Amount paid for insurance broker fees	1409
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	43
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $18,036
Total amount of fees paid to insurance company	USD $2,104
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	LTC
Welfare Benefit Premiums Paid to Carrier	USD $120,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,036
Amount paid for insurance broker fees	2104
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	THE UFER GROUP

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	569
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $96,798
Total amount of fees paid to insurance company	USD $20,321
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,204,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,281
Amount paid for insurance broker fees	19591
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	319
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,565
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,565
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	684
Insurance policy start date	2012-11-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $31
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D, TRAVEL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

7262

Policy instance

Insurance contract or identification number	7262
Number of Individuals Covered	1071
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,799
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $14,799
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND COMPANY, INC.

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

Policy contract number

226351

Policy instance

Insurance contract or identification number	226351
Number of Individuals Covered	143
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $17,939
Total amount of fees paid to insurance company	USD $2,923
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $127,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,939
Amount paid for insurance broker fees	2923
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	48
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $17,331
Total amount of fees paid to insurance company	USD $2,022
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $116,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,331
Amount paid for insurance broker fees	2022
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	THE UFER GROUP

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

Policy contract number

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	258
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,328
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,328
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND CO INC.

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	436
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $63,571
Total amount of fees paid to insurance company	USD $14,133
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $858,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,983
Amount paid for insurance broker fees	12736
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	534
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0007262-001

Policy instance

Insurance contract or identification number	0007262-001
Number of Individuals Covered	863
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,120
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $13,120
Insurance broker organization code?	3
Insurance broker name	KAPNICK AND CO INC.

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

Policy contract number

03563

Policy instance

Insurance contract or identification number	03563
Number of Individuals Covered	418
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $20,066
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $401,320
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

573367

Policy instance

Insurance contract or identification number	573367
Number of Individuals Covered	51
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $17,492
Total amount of fees paid to insurance company	USD $1,458
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $116,613
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

30022600

Policy instance

Insurance contract or identification number	30022600
Number of Individuals Covered	242
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,328
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,394
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

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	420
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $61,886
Total amount of fees paid to insurance company	USD $9,790
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $783,223
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

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	484
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0007262-001

Policy instance

Insurance contract or identification number	0007262-001
Number of Individuals Covered	846
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $13,502
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

03563

Policy instance

Insurance contract or identification number	03563
Number of Individuals Covered	425
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $19,522
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $390,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,522
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION
Insurance broker organization code?	3
Insurance broker name	NAPCO INC

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

Policy contract number

573367

Policy instance

Insurance contract or identification number	573367
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 $17,326
Total amount of fees paid to insurance company	USD $1,444
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $115,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,326
Amount paid for insurance broker fees	1444
Additional information about fees paid to insurance broker	ADDITIONAL SERVICE COMPENSATION
Insurance broker organization code?	3
Insurance broker name	UFER & COMPANY INSURANCE AGENCY

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

Policy contract number

522578

Policy instance

Insurance contract or identification number	522578
Number of Individuals Covered	429
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $62,839
Total amount of fees paid to insurance company	USD $9,892
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $791,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,839
Amount paid for insurance broker fees	9892
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	UFER & COMPANY INSURANCE AGENCY

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

Policy contract number

000099061559

Policy instance

Insurance contract or identification number	000099061559
Number of Individuals Covered	461
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $470
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0007262-001

Policy instance

Insurance contract or identification number	0007262-001
Number of Individuals Covered	834
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,300
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $12,300
Insurance broker organization code?	3
Insurance broker name	KATHERINE WOOD

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Company Name:	DICKINSON WRIGHT PLLC MASTER WELFARE BEN
Employer identification number (EIN):	381364333
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	1998-01-01
Company Identification Number:	B17482
Legal Registered Office Address:	2600 W BIG BEAVER RD STE 300 TROY United States of America (USA) 48084