GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 401k Plan overview

Plan Name	GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC
Plan identification number	501

GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 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) Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

GREEN BAY PACKAGING INC has sponsored the creation of one or more 401k plans.

Company Name:	GREEN BAY PACKAGING INC
Employer identification number (EIN):	390783183
NAIC Classification:	322100

Additional information about GREEN BAY PACKAGING INC

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	570094

More information about GREEN BAY PACKAGING INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	ADAM WINTERS	2023-10-11
501	2021-01-01	ADAM WINTERS	2022-09-28
501	2020-01-01	ADAM WINTERS	2021-07-22
501	2019-01-01	ADAM WINTERS	2020-07-27
501	2018-01-01
501	2017-01-01	ADAM WINTERS
501	2016-01-01	ADAM WINTERS
501	2015-01-01	ADAM WINTERS
501	2014-01-01	SCOTT WOCHOS
501	2013-01-01	SCOTT WOCHOS		SCOTT WOCHOS	2014-07-25
501	2012-01-01	SCOTT WOCHOS		SCOTT WOCHOS	2013-05-17
501	2011-01-01	SCOTT WOCHOS		SCOTT WOCHOS	2012-07-18
501	2010-01-01	SCOTT WOCHOS		SCOTT WOCHOS	2011-06-29
501	2009-01-01	SCOTT WOCHOS		SCOTT WOCHOS	2010-06-29

Plan Statistics for GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC

401k plan membership statisitcs for GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC

Measure	Date	Value
2022: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	4,174
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,398
Number of retired or separated participants receiving benefits	2022-01-01	712
Total of all active and inactive participants	2022-01-01	4,110
2021: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	4,106
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3,532
Number of retired or separated participants receiving benefits	2021-01-01	642
Total of all active and inactive participants	2021-01-01	4,174
2020: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	4,022
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3,492
Number of retired or separated participants receiving benefits	2020-01-01	614
Total of all active and inactive participants	2020-01-01	4,106
2019: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	3,887
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3,436
Number of retired or separated participants receiving benefits	2019-01-01	586
Total of all active and inactive participants	2019-01-01	4,022
2018: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,628
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3,322
Number of retired or separated participants receiving benefits	2018-01-01	565
Total of all active and inactive participants	2018-01-01	3,887
Total participants	2018-01-01	3,887
2017: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,534
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,080
Number of retired or separated participants receiving benefits	2017-01-01	548
Total of all active and inactive participants	2017-01-01	3,628
Total participants	2017-01-01	3,628
2016: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3,351
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3,000
Number of retired or separated participants receiving benefits	2016-01-01	534
Total of all active and inactive participants	2016-01-01	3,534
Total participants	2016-01-01	3,534
2015: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3,338
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,840
Number of retired or separated participants receiving benefits	2015-01-01	511
Total of all active and inactive participants	2015-01-01	3,351
Total participants	2015-01-01	3,351
2014: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3,312
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,840
Number of retired or separated participants receiving benefits	2014-01-01	498
Total of all active and inactive participants	2014-01-01	3,338
Total participants	2014-01-01	3,338
2013: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,220
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,829
Number of retired or separated participants receiving benefits	2013-01-01	483
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	3,312
2012: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3,158
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,749
Number of retired or separated participants receiving benefits	2012-01-01	471
Total of all active and inactive participants	2012-01-01	3,220
2011: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3,069
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,692
Number of retired or separated participants receiving benefits	2011-01-01	466
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	3,158
2010: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2010 401k membership
Total participants, beginning-of-year	2010-01-01	3,089
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,695
Number of retired or separated participants receiving benefits	2010-01-01	374
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	3,069
2009: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3,199
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,696
Number of retired or separated participants receiving benefits	2009-01-01	393
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	3,089

Form 5500 Responses for GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC

2022: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
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: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
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
2010: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GROUP INSURANCE PLAN OF GREEN BAY PACKAGING INC 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	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS07659
Policy instance	4
Insurance contract or identification number ADDS07659 Number of Individuals Covered 3360 Insurance policy start date 2021-05-01 Insurance policy end date 2022-04-30 Total amount of commissions paid to insurance broker USD $8,374 Total amount of fees paid to insurance company USD $2,087 Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $139,572 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,374 Amount paid for insurance broker fees 2087 Additional information about fees paid to insurance broker BONUS PAID Insurance broker organization code? 3
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	H2001
Policy instance	3
Insurance contract or identification number H2001 Number of Individuals Covered 411 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 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $906,367 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	2
Insurance contract or identification number 783902 S001 Number of Individuals Covered 346 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $50,051 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,502,523 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $42,532 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402620G
Policy instance	1
Insurance contract or identification number 402620G Number of Individuals Covered 3956 Insurance policy start date 2021-05-01 Insurance policy end date 2022-04-30 Total amount of commissions paid to insurance broker USD $77,969 Total amount of fees paid to insurance company USD $33,040 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,723,346 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $77,969 Amount paid for insurance broker fees 33040 Additional information about fees paid to insurance broker BONUS PAID Insurance broker organization code? 3
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	H2001
Policy instance	3
Insurance contract or identification number H2001 Number of Individuals Covered 400 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $928,310 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	2
Insurance contract or identification number 783902 S001 Number of Individuals Covered 366 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $44,017 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,176,230 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,017 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402620G
Policy instance	1
Insurance contract or identification number 402620G Number of Individuals Covered 3973 Insurance policy start date 2020-05-01 Insurance policy end date 2021-04-30 Total amount of commissions paid to insurance broker USD $83,159 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,589,427 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $83,159 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS07659
Policy instance	1
Insurance contract or identification number ADDS07659 Number of Individuals Covered 444 Insurance policy start date 2019-05-01 Insurance policy end date 2020-04-30 Total amount of commissions paid to insurance broker USD $7,136 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $118,929 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,136 Insurance broker organization code? 3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	5
Insurance contract or identification number 9065 Number of Individuals Covered 8 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $664 Total amount of fees paid to insurance company USD $402 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,294 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $664 Amount paid for insurance broker fees 402 Additional information about fees paid to insurance broker ADMIN FEES Insurance broker organization code? 3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	2
Insurance contract or identification number 783902 S001 Number of Individuals Covered 371 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $40,549 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,027,442 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $40,549 Insurance broker organization code? 3
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	H2001
Policy instance	3
Insurance contract or identification number H2001 Number of Individuals Covered 403 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $950,489 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	4
Insurance contract or identification number C08157 Number of Individuals Covered 19 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $4,550 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $205,397 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 4550 Additional information about fees paid to insurance broker SERVICE FEE Insurance broker organization code? 3
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	H2001
Policy instance	3
Insurance contract or identification number H2001 Number of Individuals Covered 395 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $863,023 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	4
Insurance contract or identification number C08157 Number of Individuals Covered 35 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $7,105 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $288,122 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 7105 Additional information about fees paid to insurance broker SERVICE FEE Insurance broker organization code? 3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	5
Insurance contract or identification number 9065 Number of Individuals Covered 12 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $963 Total amount of fees paid to insurance company USD $878 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,043 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $963 Amount paid for insurance broker fees 878 Additional information about fees paid to insurance broker ADMIN FEES Insurance broker organization code? 3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	2
Insurance contract or identification number 783902 S001 Number of Individuals Covered 385 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $39,947 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,997,364 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,947 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADD507659
Policy instance	1
Insurance contract or identification number ADD507659 Number of Individuals Covered 439 Insurance policy start date 2018-05-01 Insurance policy end date 2019-04-30 Total amount of commissions paid to insurance broker USD $6,813 Total amount of fees paid to insurance company USD $939 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $113,544 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,813 Amount paid for insurance broker fees 939 Additional information about fees paid to insurance broker BONUS PAID Insurance broker organization code? 3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00506511
Policy instance	10
Insurance contract or identification number 00506511 Number of Individuals Covered 80 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $3,188 Total amount of fees paid to insurance company USD $4,231 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $79,204 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,188 Amount paid for insurance broker fees 4231 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	8
Insurance contract or identification number 9065 Number of Individuals Covered 39 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $2,552 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $31,898 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,552 Insurance broker organization code? 3 Insurance broker name HUB INTERNATIONAL PLAN BENEFIT ANAL
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	7
Insurance contract or identification number C08157 Number of Individuals Covered 106 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of fees paid to insurance company USD $21,140 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $726,467 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 21140 Additional information about fees paid to insurance broker SERVICE FEE Insurance broker organization code? 3 Insurance broker name HUB INTERNATIONAL MIDWEST LIMITED P
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	28998*POSA
Policy instance	6
Insurance contract or identification number 28998*POSA Number of Individuals Covered 19 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $74,837 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 )
Policy contract number	C0004403191
Policy instance	5
Insurance contract or identification number C0004403191 Number of Individuals Covered 227 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $39,605 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,853 Insurance broker organization code? 3 Insurance broker name ASSOCIATED BENEFITS & RISK CON
SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 )
Policy contract number	C0004403197
Policy instance	9
Insurance contract or identification number C0004403197 Number of Individuals Covered 31 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $6,492 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,714 Insurance broker organization code? 3 Insurance broker name ASSOCIATED BENEFITS & RISK CON
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	2
Insurance contract or identification number 783902 S001 Number of Individuals Covered 384 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $38,481 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,924,034 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,481 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	28998
Policy instance	3
Insurance contract or identification number 28998 Number of Individuals Covered 179 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $782,506 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	H2001
Policy instance	4
Insurance contract or identification number H2001 Number of Individuals Covered 396 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $815,388 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	402620G
Policy instance	1
Insurance contract or identification number 402620G Number of Individuals Covered 3507 Insurance policy start date 2016-05-01 Insurance policy end date 2017-04-30 Total amount of commissions paid to insurance broker USD $57,577 Total amount of fees paid to insurance company USD $14,395 Life Insurance Welfare Benefit Yes Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $959,653 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $57,577 Amount paid for insurance broker fees 14395 Additional information about fees paid to insurance broker BONUS PAID Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 87 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $9,069 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $55,752 Commission paid to Insurance Broker USD $9,069 Insurance broker organization code? 3 Insurance broker name SVIHOVEC, DEBRA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402620G
Policy instance	2
Insurance contract or identification number 402620G Number of Individuals Covered 3327 Insurance policy start date 2014-05-01 Insurance policy end date 2015-04-30 Total amount of commissions paid to insurance broker USD $48,423 Total amount of fees paid to insurance company USD $19,480 Life Insurance Welfare Benefit Yes Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $807,015 Commission paid to Insurance Broker USD $48,423 Insurance broker organization code? 3 Amount paid for insurance broker fees 19480 Additional information about fees paid to insurance broker BONUS PAID Insurance broker name ASSOCIATED FINANCIAL GROUP LLC
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number	783902 S001
Policy instance	3
Insurance contract or identification number 783902 S001 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $119 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,989 Commission paid to Insurance Broker USD $119 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792
Policy instance	4
Insurance contract or identification number 18792 Number of Individuals Covered 169 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $19,069 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $705,011 Commission paid to Insurance Broker USD $19,069 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H2001
Policy instance	5
Insurance contract or identification number H2001 Number of Individuals Covered 387 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $720,382
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	10004452
Policy instance	6
Insurance contract or identification number 10004452 Number of Individuals Covered 118 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $47,480 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,583,395 Commission paid to Insurance Broker USD $47,480 Insurance broker organization code? 3 Insurance broker name CLARK THEILIG
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	8
Insurance contract or identification number C08157 Number of Individuals Covered 142 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $25,145 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $745,442 Commission paid to Insurance Broker USD $8,470 Insurance broker organization code? 3 Insurance broker name PLAN BENEFIT ANALYSIS OF TULSA, INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	9
Insurance contract or identification number 9065 Number of Individuals Covered 48 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $2,846 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $35,575 Commission paid to Insurance Broker USD $2,846 Insurance broker organization code? 3 Insurance broker name HUB INTERNATIONAL PLAN BENEFIT ANAL
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	10
Insurance contract or identification number 783902 S001 Number of Individuals Covered 370 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $33,166 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,675,230 Commission paid to Insurance Broker USD $33,166 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00506511
Policy instance	11
Insurance contract or identification number 00506511 Number of Individuals Covered 76 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,492 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $62,622 Commission paid to Insurance Broker USD $2,492 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES INC
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792POSA
Policy instance	7
Insurance contract or identification number 18792POSA Number of Individuals Covered 12 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $58,584
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	11
Insurance contract or identification number 783902 S001 Number of Individuals Covered 373 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $30,916 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,570,113 Commission paid to Insurance Broker USD $30,916 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	10
Insurance contract or identification number 9065 Number of Individuals Covered 40 Insurance policy start date 2013-08-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $3,053 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $38,158 Commission paid to Insurance Broker USD $3,053 Insurance broker organization code? 3 Insurance broker name PLAN BENEFIT ANALYSTS OF TULSA INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	F1D1528
Policy instance	12
Insurance contract or identification number F1D1528 Number of Individuals Covered 78 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,981 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $67,490 Commission paid to Insurance Broker USD $2,981 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES INC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 225 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $3,961 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,408,605 Commission paid to Insurance Broker USD $3,961 Insurance broker organization code? 3 Insurance broker name SVIHOVEC, DEBRA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS07659
Policy instance	2
Insurance contract or identification number ADDS07659 Number of Individuals Covered 443 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $6,567 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $109,447 Commission paid to Insurance Broker USD $6,567 Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402620G
Policy instance	3
Insurance contract or identification number 402620G Number of Individuals Covered 3338 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $48,067 Other welfare benefits provided VOLUNTARY AD&D Welfare Benefit Premiums Paid to Carrier USD $783,345 Commission paid to Insurance Broker USD $48,067 Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number	783902 S001
Policy instance	4
Insurance contract or identification number 783902 S001 Number of Individuals Covered 3 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $327 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $16,563 Commission paid to Insurance Broker USD $327 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792
Policy instance	5
Insurance contract or identification number 18792 Number of Individuals Covered 169 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $633,692
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H1509
Policy instance	6
Insurance contract or identification number H1509 Number of Individuals Covered 381 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $675,713
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	10004452
Policy instance	7
Insurance contract or identification number 10004452 Number of Individuals Covered 127 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $48,405 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,613,431 Commission paid to Insurance Broker USD $48,405 Insurance broker organization code? 3 Insurance broker name SPECTRUM BENEFIT SOLUTION CE WI LLC
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792POSA
Policy instance	8
Insurance contract or identification number 18792POSA Number of Individuals Covered 10 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $43,311
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	9
Insurance contract or identification number C08157 Number of Individuals Covered 117 Insurance policy start date 2013-08-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $24,112 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $723,702 Commission paid to Insurance Broker USD $14,798 Insurance broker organization code? 3 Insurance broker name PLAN BENEFIT ANALYSIS OF TULSA, INC
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number	783902 S001
Policy instance	5
Insurance contract or identification number 783902 S001 Number of Individuals Covered 3 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $327 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,363 Commission paid to Insurance Broker USD $327 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS07659
Policy instance	2
Insurance contract or identification number ADDS07659 Number of Individuals Covered 453 Insurance policy start date 2012-05-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $3,269 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $54,477 Commission paid to Insurance Broker USD $3,269 Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX964055
Policy instance	6
Insurance contract or identification number FLX964055 Number of Individuals Covered 3152 Insurance policy start date 2012-05-01 Insurance policy end date 2013-04-30 Total amount of commissions paid to insurance broker USD $38,171 Total amount of fees paid to insurance company USD $19,231 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $763,416 Commission paid to Insurance Broker USD $38,171 Amount paid for insurance broker fees 19231 Additional information about fees paid to insurance broker OVERRIDE Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	965675
Policy instance	4
Insurance contract or identification number 965675 Number of Individuals Covered 2773 Insurance policy start date 2012-05-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $5,351 Total amount of fees paid to insurance company USD $3,807 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $107,019 Commission paid to Insurance Broker USD $5,351 Amount paid for insurance broker fees 3807 Additional information about fees paid to insurance broker OVERRIDE Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402620G
Policy instance	3
Insurance contract or identification number 402620G Number of Individuals Covered 3256 Insurance policy start date 2013-05-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $27,197 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $453,293 Commission paid to Insurance Broker USD $27,197 Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792
Policy instance	7
Insurance contract or identification number 18792 Number of Individuals Covered 165 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $20,559 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $557,973 Commission paid to Insurance Broker USD $20,559 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H1509
Policy instance	8
Insurance contract or identification number H1509 Number of Individuals Covered 386 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $611,740
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	12
Insurance contract or identification number 9065 Number of Individuals Covered 49 Insurance policy start date 2012-08-01 Insurance policy end date 2013-07-31 Total amount of commissions paid to insurance broker USD $3,441 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $43,013 Commission paid to Insurance Broker USD $3,441 Insurance broker organization code? 3 Insurance broker name CONNIE J FRIEDL-WRIGHT
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	10004452
Policy instance	9
Insurance contract or identification number 10004452 Number of Individuals Covered 114 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $41,777 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,392,687 Commission paid to Insurance Broker USD $41,777 Insurance broker organization code? 3 Insurance broker name SPECTRUM BENEFIT SOLUTION CE WI LLC
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	11
Insurance contract or identification number C08157 Number of Individuals Covered 153 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $20,486 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $779,315 Commission paid to Insurance Broker USD $20,486 Insurance broker organization code? 3 Insurance broker name CONNIE J FRIEDL WRIGHT
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	13
Insurance contract or identification number 783902 S001 Number of Individuals Covered 383 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $31,344 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,564,300 Commission paid to Insurance Broker USD $31,344 Insurance broker organization code? 3 Insurance broker name ROGUS , EVE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05737525
Policy instance	14
Insurance contract or identification number TM05737525 Number of Individuals Covered 277 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $2,857 Total amount of fees paid to insurance company USD $489 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $66,890 Commission paid to Insurance Broker USD $2,857 Amount paid for insurance broker fees 489 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES INC
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792POSA
Policy instance	10
Insurance contract or identification number 18792POSA Number of Individuals Covered 9 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $26,949
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 223 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $9,989 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,273,912 Commission paid to Insurance Broker USD $9,989 Insurance broker organization code? 3 Insurance broker name SVIHOVEC,DEBRA
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS08067
Policy instance	2
Insurance contract or identification number ADDS08067 Number of Individuals Covered 452 Insurance policy start date 2011-05-01 Insurance policy end date 2012-04-30 Total amount of commissions paid to insurance broker USD $1,866 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $12,441 Commission paid to Insurance Broker USD $1,866 Insurance broker organization code? 3 Insurance broker name HILB ROGAL & HOBBS
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	783902 S001
Policy instance	14
Insurance contract or identification number 783902 S001 Number of Individuals Covered 361 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $32,998 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,649,925 Commission paid to Insurance Broker USD $32,998 Insurance broker organization code? 3 Insurance broker name ROGUS , EVE
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 222 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $8,950 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,246,691 Commission paid to Insurance Broker USD $8,950 Insurance broker organization code? 3 Insurance broker name SVIHOVEC,DEBRA
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05737525
Policy instance	15
Insurance contract or identification number TM05737525 Number of Individuals Covered 84 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $2,740 Total amount of fees paid to insurance company USD $377 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $60,795 Commission paid to Insurance Broker USD $2,740 Amount paid for insurance broker fees 377 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES INC
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	250808
Policy instance	13
Insurance contract or identification number 250808 Number of Individuals Covered 151 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $13,702 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $441,968 Commission paid to Insurance Broker USD $13,702 Insurance broker organization code? 3 Insurance broker name CONNIE J FRIEDL-WRIGHT
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	250808
Policy instance	12
Insurance contract or identification number 250808 Number of Individuals Covered 151 Insurance policy start date 2011-08-01 Insurance policy end date 2012-07-31 Total amount of commissions paid to insurance broker USD $24,161 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $768,432 Commission paid to Insurance Broker USD $24,161 Insurance broker organization code? 3 Insurance broker name CONNIE J FRIEDL-WRIGHT
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	C08157
Policy instance	11
Insurance contract or identification number C08157 Number of Individuals Covered 153 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $10,672 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $334,651 Commission paid to Insurance Broker USD $10,672 Insurance broker organization code? 3 Insurance broker name CONNIE J FRIEDL WRIGHT
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792POSA
Policy instance	10
Insurance contract or identification number 18792POSA Number of Individuals Covered 10 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $40,873
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	170640
Policy instance	9
Insurance contract or identification number 170640 Number of Individuals Covered 110 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $41,938 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,397,932 Commission paid to Insurance Broker USD $41,938 Insurance broker organization code? 3 Insurance broker name SPECTRUM BENEFIT SOLUTION CE WI LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H1509
Policy instance	8
Insurance contract or identification number H1509 Number of Individuals Covered 384 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $549,074
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792
Policy instance	7
Insurance contract or identification number 18792 Number of Individuals Covered 162 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $20,004 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $530,668 Commission paid to Insurance Broker USD $20,004 Insurance broker organization code? 3 Insurance broker name BB & T INSURANCE SERVICES
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	6
Insurance contract or identification number 9065 Number of Individuals Covered 43 Insurance policy start date 2011-08-01 Insurance policy end date 2012-07-31 Total amount of commissions paid to insurance broker USD $2,635 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $32,942 Commission paid to Insurance Broker USD $2,635 Insurance broker organization code? 3 Insurance broker name CONNIE FRIEDL-WRIGHT
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number	783902
Policy instance	5
Insurance contract or identification number 783902 Number of Individuals Covered 3 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $392 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,590 Commission paid to Insurance Broker USD $392 Insurance broker organization code? 3 Insurance broker name ROGUS, EVE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX964055
Policy instance	4
Insurance contract or identification number FLX964055 Number of Individuals Covered 3152 Insurance policy start date 2011-05-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $38,073 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $761,454 Commission paid to Insurance Broker USD $38,073 Insurance broker organization code? 3 Insurance broker name ASSOCIATED FINANCIAL GROUP
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	T5MP-34317
Policy instance	3
Insurance contract or identification number T5MP-34317 Number of Individuals Covered 2749 Insurance policy start date 2011-03-01 Insurance policy end date 2012-02-28 Total amount of commissions paid to insurance broker USD $306 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP TRAVEL AND ACCIDENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,062 Commission paid to Insurance Broker USD $306 Insurance broker organization code? 3 Insurance broker name AON CUNSULTING
HEALTH PARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 215 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $8,310 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,087,963
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05737525
Policy instance	4
Insurance contract or identification number TM05737525 Number of Individuals Covered 243 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $2,672 Total amount of fees paid to insurance company USD $1,142 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $57,155
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	170640
Policy instance	9
Insurance contract or identification number 170640 Number of Individuals Covered 117 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $44,246 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	HD0168
Policy instance	11
Insurance contract or identification number HD0168 Number of Individuals Covered 0 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $3,373 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $59,335
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792POSA
Policy instance	10
Insurance contract or identification number 18792POSA Number of Individuals Covered 3 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $20,690
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H5435
Policy instance	8
Insurance contract or identification number H5435 Number of Individuals Covered 383 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $545,603
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )
Policy contract number	18792
Policy instance	7
Insurance contract or identification number 18792 Number of Individuals Covered 70 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $17,711 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $485,327
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	6
Insurance contract or identification number 9065 Number of Individuals Covered 49 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Total amount of commissions paid to insurance broker USD $2,470 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number	0583
Policy instance	5
Insurance contract or identification number 0583 Number of Individuals Covered 173 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? Yes Were dividends or retroactive rate refunds paid as a credit? No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	T5MP-34317
Policy instance	3
Insurance contract or identification number T5MP-34317 Number of Individuals Covered 2914 Insurance policy start date 2010-03-01 Insurance policy end date 2011-02-28 Total amount of commissions paid to insurance broker USD $306 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP TRAVEL AND ACCIDENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,062
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS08067
Policy instance	2
Insurance contract or identification number ADDS08067 Number of Individuals Covered 2642 Insurance policy start date 2010-05-01 Insurance policy end date 2011-04-30 Total amount of commissions paid to insurance broker USD $11,082 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $73,881
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	250808
Policy instance	12
Insurance contract or identification number 250808 Number of Individuals Covered 163 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Total amount of commissions paid to insurance broker USD $24,005 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $736,657
COMMUNITYCARE (National Association of Insurance Commissioners NAIC id number: 89008 )
Policy contract number	ICRR19
Policy instance	13
Insurance contract or identification number ICRR19 Number of Individuals Covered 0 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Total amount of commissions paid to insurance broker USD $88 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0
HEALTH PARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number	0517
Policy instance	1
Insurance contract or identification number 0517 Number of Individuals Covered 208 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $7,942 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $943,567
COMMUNITYCARE (National Association of Insurance Commissioners NAIC id number: 89008 )
Policy contract number	ICRR19
Policy instance	14
Insurance contract or identification number ICRR19 Number of Individuals Covered 1 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Total amount of commissions paid to insurance broker USD $427 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,233
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	ADDS08067
Policy instance	2
Insurance contract or identification number ADDS08067 Number of Individuals Covered 2668 Insurance policy start date 2009-05-01 Insurance policy end date 2010-04-30 Total amount of commissions paid to insurance broker USD $11,276 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $75,175
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )
Policy contract number	170640
Policy instance	9
Insurance contract or identification number 170640 Number of Individuals Covered 117 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $43,295 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	H5435
Policy instance	8
Insurance contract or identification number H5435 Number of Individuals Covered 374 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $34,784 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $365,569
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number	9065
Policy instance	6
Insurance contract or identification number 9065 Number of Individuals Covered 50 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Total amount of commissions paid to insurance broker USD $2,590 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )
Policy contract number	62675
Policy instance	7
Insurance contract or identification number 62675 Number of Individuals Covered 22 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $7,540 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $215,433
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	HD0168
Policy instance	11
Insurance contract or identification number HD0168 Number of Individuals Covered 16 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $7,246 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $143,806
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number	0583
Policy instance	5
Insurance contract or identification number 0583 Number of Individuals Covered 313 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $24,276 Total amount of fees paid to insurance company USD $1,100 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05737525
Policy instance	4
Insurance contract or identification number TM05737525 Number of Individuals Covered 254 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,631 Total amount of fees paid to insurance company USD $1,081 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $53,976
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number	250808
Policy instance	13
Insurance contract or identification number 250808 Number of Individuals Covered 61 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Total amount of commissions paid to insurance broker USD $23,576 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $712,039
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	T5MP-34317
Policy instance	3
Insurance contract or identification number T5MP-34317 Number of Individuals Covered 2923 Insurance policy start date 2009-03-01 Insurance policy end date 2010-02-28 Total amount of commissions paid to insurance broker USD $306 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP TRAVEL AND ACCIDENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,062
OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )
Policy contract number	65701
Policy instance	12
Insurance contract or identification number 65701 Number of Individuals Covered 32 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $9,258 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $264,524
OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )
Policy contract number	18792
Policy instance	10
Insurance contract or identification number 18792 Number of Individuals Covered 32 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $3,011 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $86,040

Potentially related plans

• GROUP INSURANCE PLAN OF STEPHEN GOULD CORPORATION [EIN = 221550787]
• GROUP INSURANCE FOR EMPLOYEES OF EMPLOYEE OWNED BRANDS, INC. [EIN = 420990485]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF WEST BANCORPORATION, INC. [EIN = 421230603]
• GROUP INSURANCE PLAN FOR THE PHPA/ECHL HEALTH AND WELFARE TRUST [EIN = 980363136]
• GROUP INSURANCE FOR HOURLY EMPLOYEES OF POLARIS INDUSTRIES INC. [EIN = 411857431]
• GROUP INSURANCE FOR EMPLOYEES OF THE DAILY NEWS-TRIBUNE, INC. AND LASALLE COUNTY BROADCASTING CORP. [EIN = 360973150]
• GROUP INSURANCE PLAN PRUDENTIAL [EIN = 520964501]
• GROUP INSURANCE PLAN [EIN = 362423707]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF THE WOOSTER BRUSH CO [EIN = 340628460]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF GARAN INCORPORATED [EIN = 135665557]
• GROUP INSURANCE PLAN FOR THE OLD SPAGHETTI FACTORY [EIN = 910889806]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF PALMETTO SYNTHETICS, LLC [EIN = 621731448]
• GROUP INSURANCE PLAN - HYNES INDUSTRIES, INC, [EIN = 340971763]
• GROUP INSURANCE PLAN FOR SALARIED AND HOURLY EMPLOYEES [EIN = 060513860]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF VIRGINIA HEALTH SERVICES, INC. [EIN = 541141438]
• GROUP INSURANCE PLAN [EIN = 621348671]
• GROUP INSURANCE PROTECTION FOR EMPLOYEES OF AIR INDUSTRIES COMPANY [EIN = 231116110]
• GROUP INSURANCE PLAN FOR RETIRED EMPLOYEES OF MURPHY OIL CORPORATION [EIN = 710361522]
• GROUP INSURANCE PLAN OF HODNETTE MEDICAL CENTER CLINIC PA [EIN = 592193856]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS CORPORATION, FORT WORTH DIVISION [EIN = 131673581]
• GROUP INSURANCE PLAN OF WALTER DORWIN TEAGUE [EIN = 132587094]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF POINT PARK UNIVERSITY [EIN = 251094922]
• GROUP INSURANCE PLAN OF BROOKLYN BUREAU OF COMMUNITY SERVICE [EIN = 111630780]
• GROUP INSURANCE PLAN FOR COLUMBIA SPORTSWEAR COMPANY [EIN = 930498284]
• GROUP INSURANCE LIFE PLAN [EIN = 261974324]
• GROUP INSURANCE PLAN OF AUGUSTA RIVERFRONT LLC [EIN = 581843423]
• GROUP INSURANCE PLAN [EIN = 660231175]
• GROUP INSURANCE PLAN FOR SALEM HEALTH [EIN = 930823471]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF HARLEY-DAVIDSON MOTOR COMPANY GROUP LLC [EIN = 391805420]
• GROUP INSURANCE PLAN OF MORRIS COMMUNICATIONS COMPANY [EIN = 581093347]
• GROUP INSURANCE FOR EMPLOYEES OF SDL [EIN = 542003261]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF LENDING SOLUTIONS, INC. [EIN = 363939532]
• GROUP INSURANCE PLAN [EIN = 222883487]
• GROUP INSURANCE - LIFE, LONG TERM CARE, LONG TERM, DISABILITY, ACCIDENTAL DEATH & DISABILITY [EIN = 381624684]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES [EIN = 341506654]
• GROUP INSURANCE PLAN FOR RETIREES AND THEIR DEPENDENTS [EIN = 270056662]
• GROUP INSURANCE PLAN [EIN = 721577383]
• GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. [EIN = 230814690]
• GROUP INSURANCE PLAN FOR EMPLOYEES AND THEIR DEPEN DENTS [EIN = 270056662]
• GROUP INSURANCE PLAN MOUNT VERNON [EIN = 520422760]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MARVIN LUMBER AND CEDAR COMPANY [EIN = 410396845]
• GROUP INSURANCE PLAN FOR EMPLOYEES [EIN = 591270754]
• GROUP INSURANCE PLAN [EIN = 470663756]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF VOLKSWAGEN GROUP OF AMERICA, INC. [EIN = 221585834]
• GROUP INSURANCE PLAN FOR PETROLIA HOURLY RETIREES [EIN = 251720937]
• GROUP INSURANCE AND HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS CORPORATION, MATERIAL SERVICE CORPORATION [EIN = 131673581]
• GROUP INSURANCE PLAN FOR RETIREES OF BRIGGS & STRATTON CORPORATION [EIN = 390182330]
• GROUP INSURANCE PLAN OF DRUMMOND COAL COMPANY [EIN = 630653224]
• GROUP INSURANCE PLAN FOR CERTAIN EMPLOYEES OF ANHEUSER-BUSCH COMPANIES, LLC [EIN = 431162835]
• GROUP INSURANCE PLAN FOR RETIRED EMPLOYEES OF AMERICAN WATER WORKS CO., INC. & ITS DESIGNATED SUBSIDIARIES & AFFILIATES [EIN = 510063696]
• GROUP INSURANCE PLAN FOR FULLTIME UNION AND NON-UNION EMPLOYEES [EIN = 910498657]
• GROUP INSURANCE PLAN LIFE INSURANCE PLAN [EIN = 371225456]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS CORPORATION, ELECTRIC BOAT DIVISION [EIN = 131673581]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF FIRST BANCORP [EIN = 561421916]
• GROUP INSURANCE PLAN AD&D INSURANCE [EIN = 371225456]
• GROUP INSURANCE PLAN [EIN = 910208860]
• GROUP INSURANCE PLAN FOR RETAIL FIELD HOURLY EMPLOYEES OF MURPHY USA, INC. [EIN = 462279221]
• GROUP INSURANCE PLAN [EIN = 231003740]
• GROUP INSURANCE PLAN [EIN = 461031856]
• GROUP INSURANCE PLAN FOR SILTRONIC CORPORATION [EIN = 942518330]
• GROUP INSURANCE PLAN [EIN = 340863886]
• GROUP INSURANCE PLAN [EIN = 522399960]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MURPHY USA INC. [EIN = 462279221]
• GROUP INSURANCE PLAN OF THE LUBRIZOL CORPORATION [EIN = 340367600]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF DB US HOLDING CORPORATION [EIN = 131947012]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF NW ENTERTAINMENT, INC. [EIN = 954440178]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY [EIN = 350869045]
• GROUP INSURANCE PLAN OF BLUESCOPE STEEL NORTH AMERICA [EIN = 232081882]
• GROUP INSURANCE PLAN OF BRADLEY CORPORATION [EIN = 390178880]
• GROUP INSURANCE PLAN LIFE INSURANCE [EIN = 371225456]
• GROUP INSURANCE PLAN [EIN = 042210685]
• GROUP INSURANCE & HEALTH BENEFITS FOR HOURLY EMPLOYEES OF GENERAL DYNAMICS CORPORATION, CONVAIR DIVISION [EIN = 131673581]
• GROUP INSURANCE [EIN = 222484310]
• GROUP INSURANCE PLAN VIKING PUMP HOURLY EMPLOYEES LOCAL 1728 [EIN = 133372066]
• GROUP INSURANCE PLAN FOR KING RANCH, INC. 3 RIVERWAY, SUITE 1600 HOUSTON, TX 77056-1967 [EIN = 740726547]
• GROUP INSURANCE PLAN OF DAVIS H ELLIOT COMPANY [EIN = 541203551]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF HANNA, BROPHY, MACLEAN, MCALEER, JENSEN LLP [EIN = 942709617]
• GROUP INSURANCE WILLIAM CHARLES, LTD. [EIN = 363156433]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF GENUINE PARTS COMPANY [EIN = 580254510]
• GROUP INSURANCE FOR FULL-TIME EMPLOYEES [EIN = 510054940]
• GROUP INSURANCE PLAN [EIN = 954605850]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF CHARLESTON SOUTHERN UNIVERSITY [EIN = 570474291]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED NON-BARGAINING EMPLOYEES OF GENERAL DYNAMICS LAND SYSTEMS [EIN = 131673581]
• GROUP INSURANCE PLAN [EIN = 470460284]
• GROUP INSURANCE PLANS FOR EMPLOYEES OF CONSOLIDATED SYSTEMS, INC. [EIN = 570508744]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF HUGHES BROTHERS, INC. [EIN = 470354103]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES [EIN = 203928590]
• GROUP INSURANCE PLAN [EIN = 112233773]
• GROUP INSURANCE PLAN [EIN = 364338724]
• GROUP INSURANCE PLAN FOR SALARIED EMPLOYEES [EIN = 203928590]
• GROUP INSURANCE PLAN OF THE JONES METAL PRODUCTS COMPANY [EIN = 314220410]
• GROUP INSURANCE PLAN OF HAMMOND & IRVING, INC. [EIN = 150331570]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF INTERSTATE HARDWOODS [EIN = 550691332]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF GOLDEN STATE FOODS CORP [EIN = 952670074]
• GROUP INSURANCE PLAN FOR BETHESDA HEALTH GROUP INC. [EIN = 430666738]
• GROUP INSURANCE AND HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS CORPORATION, CONVAIR DIVISION [EIN = 131673581]
• GROUP INSURANCE AND HEALTH BENEFITS FOR HOURLY EMPLOYEES OF GENERAL DYNAMICS CORPORATION, AIR DEFENSE SYSTEMS DIVISION, POMONA FACILITY [EIN = 131673581]
• GROUP INSURANCE PLAN FOR LIEBHERR AMERICA INC. [EIN = 540885749]
• GROUP INSURANCE PLAN [EIN = 952547124]
• GROUP INSURANCE PLAN - ALL EMPLOYEES OF SANDVIK, INC. [EIN = 221717737]
• GROUP INSURANCE PLAN WOLVERINE & RETAIL [EIN = 381185150]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF BLACK HILLS CORPORATION [EIN = 460458824]
• GROUP INSURANCE FOR BARGAINING UNIT EMPLOYEES OF ELECTRIC ENERGY, INC. [EIN = 370673432]
• GROUP INSURANCE PLAN FOR ACTIVE EMPLOYEES OF AMERICAN WATER WORKS CO., INC. & ITS DESIGNATED SUBSIDIARIES & AFFILIATES [EIN = 510063696]
• GROUP INSURANCE PLAN [EIN = 382144267]
• GROUP INSURANCE ARRANGEMENT OF WELFARE PLANS [EIN = 381459362]
• GROUP INSURANCE PLANS OF MARUBENI AMERICA CORPORATION [EIN = 135643190]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. [EIN = 630476716]
• GROUP INSURANCE PLAN FOR FRERES LUMBER CO. INC. [EIN = 930357299]
• GROUP INSURANCE PLAN OF JOHN D. HOLLINGSWORTH ON WHEELS INC [EIN = 570468454]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF ALFRED BENESCH & COMPANY [EIN = 362407363]
• GROUP INSURANCE PLAN OF HOSPICE OF THE WESTERN RESERVE [EIN = 341256377]
• GROUP INSURANCE PLAN [EIN = 470355979]
• GROUP INSURANCE PLANS [EIN = 470363909]
• GROUP INSURANCE PLAN FOR FRERES LUMBER CO INC [EIN = 930357299]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS CORPORATION, SPACE SYSTEMS DIVISION [EIN = 131673581]
• GROUP INSURANCE PLAN OF THE MACLEAN-FOGG COMPANY [EIN = 362431745]
• GROUP INSURANCE PLAN OF BRIGGS & STRATTON CORP. [EIN = 390182330]
• GROUP INSURANCE PLAN [EIN = 042503926]
• GROUP INSURANCE FOR MANAGEMENT EMPLOYEES OF ELECTRIC ENERGY, INC. [EIN = 370673432]
• GROUP INSURANCE FOR EMPLOYEES OF BOSSONG HOSIERY MILLS, INC. [EIN = 131776424]
• GROUP INSURANCE PLAN FOR NON-UNION EMPLOYEES [EIN = 952759017]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF RICART AUTOMOTIVE PERSONNEL, INC. [EIN = 311314576]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF VOGUE TYRE AND RUBBER COMPANY [EIN = 361917460]
• GROUP INSURANCE PLAN FOR RETIREES OF G&L USA, LLC [EIN = 223876474]
• GROUP INSURANCE PLAN [EIN = 453776966]
• GROUP INSURANCE PLAN OF THE KENDAL CORPORATION [EIN = 232688382]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF CRANE [EIN = 041215780]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF LONZA INC. REPRESENTED BY UNITED STEELWORKERS OF AMERICA [EIN = 135665861]
• GROUP INSURANCE PLAN [EIN = 521191617]
• GROUP INSURANCE PLAN [EIN = 470670369]
• GROUP INSURANCE HEALTH AND DENTAL [EIN = 221977697]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF THE AMERICAN CIVIL LIBERTIES UNION FOUNDATION, INC. [EIN = 136213516]
• GROUP INSURANCE PLAN DISABILITY INSURANCE PLAN [EIN = 371225456]
• GROUP INSURANCE PLAN FOR CERTAIN RETIRED EMPLOYEES OF PARKER HANNIFIN CORP [EIN = 340451060]
• GROUP INSURANCE FOR SALARIED EMPLOYEES OF POLARIS INDUSTRIES INC. [EIN = 411857431]
• GROUP INSURANCE PLAN OF HUBBELL, ROTH AND CLARK, INC [EIN = 380668370]
• GROUP INSURANCE PLAN UNDER THE AMERICAN INSTITUTE OF CPAS [EIN = 310897727]
• GROUP INSURANCE PLAN FOR EMPLOYEES AND THEIR DEPENDENTS [EIN = 270056662]
• GROUP INSURANCE PLAN [EIN = 361058780]
• GROUP INSURANCE PLAN FOR SALARIED & HOURLY EMPLOYE [EIN = 251116726]
• GROUP INSURANCE FOR GRAIN MILLER EMPLOYEES [EIN = 410274440]
• GROUP INSURANCE BENEFITS FOR EMPLOYEES OF A CLEANER WORLD [EIN = 560937612]
• GROUP INSURANCE FOR EMPLOYEES OF ENOVIS CORPORATION [EIN = 541887631]
• GROUP INSURANCE PLAN OF UTICA MUTUAL INSURANCE EMPLOYEES [EIN = 150476880]
• GROUP INSURANCE PLAN OF THE OKONITE COMPANY [EIN = 222279445]
• GROUP INSURANCE PLAN [EIN = 364431179]
• GROUP INSURANCE PLAN 502 [EIN = 470363104]
• GROUP INSURANCE FOR EMPLOYEES OF ROYAL OAK ENTERPRISES, LLC [EIN = 582496832]
• GROUP INSURANCES [EIN = 300521689]
• GROUP INSURANCE PLAN [EIN = 462955848]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MOTLEY RICE LLC [EIN = 753051732]
• GROUP INSURANCE PLAN [EIN = 611088522]
• GROUP INSURANCE & HEALTH BENEFITS FOR HOURLY EMPLOYEES OF GENERAL DYNAMICS CORPORATION, FORT WORTH DIVISION [EIN = 131673581]
• GROUP INSURANCE & HEALTH BENEFITS FOR HOURLY EMPLOYEES OF GENERAL DYNAMICS CORPORATION, ELECTRIC BOAT DIVISION [EIN = 131673581]
• GROUP INSURANCE PLAN OF ECLIPSE, INC. [EIN = 361022250]
• GROUP INSURANCE PLAN [EIN = 910876461]
• GROUP INSURANCE PLAN FOR ELIGIBLE EMPLOYEES OF PMX INDUSTRIES, INC. [EIN = 943105200]
• GROUP INSURANCE PLAN AT BUSH BROTHERS & COMPANY [EIN = 620145910]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF REXAM, INC. [EIN = 061122239]
• GROUP INSURANCE PLAN FOR EMPLOYEES AND RETIREES OF REVERE COPPER PRODUCTS, INC. [EIN = 161146203]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SUN CHEMICAL CORPORATION [EIN = 222761297]
• GROUP INSURANCE PLAN FOR CRANE & CO., INC. [EIN = 041215780]
• GROUP INSURANCE TRUST OF THE CALIFORNIA SOCIETY OF CERTIFIED PUBLIC ACCOUNTANTS [EIN = 941056137]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED CORPORATE PERSONNEL [EIN = 131673581]
• GROUP INSURANCE PLAN VIKING PUMP HOURLY EMPLOYEES LOCAL 459 [EIN = 133372066]
• GROUP INSURANCE PLAN FOR CERTAIN RETIREES OF ANHEUSER-BUSCH COMPANIES, LLC AND ITS SUBSIDIARIES [EIN = 431162835]
• GROUP INSURANCE PLAN FOR BARGAINING UNIT EMPLOYEES [EIN = 232617050]
• GROUP INSURANCE [EIN = 041663150]
• GROUP INSURANCE FOR EMPLOYEES OF DEGOLYER & MACNAUGHTON [EIN = 750771709]
• GROUP INSURANCE MEDICAL DENTAL PLAN [EIN = 951958272]
• GROUP INSURANCE PLAN FOR MURPHY OIL CORPORATION [EIN = 710361522]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF USPA [EIN = 751054341]
• GROUP INSURANCE PLAN [EIN = 420662937]
• GROUP INSURANCE PLAN [EIN = 931074455]
• GROUP INSURANCE PLAN FOR PETROLIA HOURLY EMPLOYEES [EIN = 251720937]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF HENRY VISCARDI SCHOOL [EIN = 112024514]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF JACKSON ELECTRIC MEMBERSHIP CORPORATION [EIN = 580301471]
• GROUP INSURANCE PLAN FOR HARNISH GROUP INC. [EIN = 911978007]
• GROUP INSURANCE PLAN HOURLY AND SALARIED EMPLOYEES OF PARKER HANNIFIN CORP [EIN = 340451060]
• GROUP INSURANCE FOR EMPLOYEES OF OHIO GAS COMPANY [EIN = 344320120]
• GROUP INSURANCE PLAN [EIN = 340863886]
• GROUP INSURANCE PLAN FOR EMPLOYEES [EIN = 590630270]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF THE AMERICAN CIVIL LIBERTIES UNION, INC. [EIN = 133871360]
• GROUP INSURANCE PLAN OF ASHWORTH BROS., INC. [EIN = 320002391]
• GROUP INSURANCE FOR EMPLOYEES OF HACKENSACK UNIVERSITY MEDICAL CENTER [EIN = 221487576]
• GROUP INSURANCE PLANS [EIN = 134924125]
• GROUP INSURANCE PLAN CLARK MICHIGAN COMPANY RETIRED SALARY EMPLOYEES [EIN = 382496821]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MAGNESITA REFRACTORIES COMPANY [EIN = 230380777]
• GROUP INSURANCE PLAN [EIN = 113523578]
• GROUP INSURANCE PLAN TRAVEL ACCIDENT INSURANCE PLAN [EIN = 371225456]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF SPRINGFIELD CLINIC [EIN = 370701328]
• GROUP INSURANCE ASSOCIATES 401 K PROFIT SHARING PLAN TRUST [EIN = 061423803]
• GROUP INSURANCE [EIN = 510070531]
• GROUP INSURANCE SOLUTIONS, INC. 401K PLAN [EIN = 043448161]
• GROUP INSURANCE SERVICE CENTER, INC 401(K) PROFIT SHARING PLAN [EIN = 043271304]
• GROUP INSURANCE PLANNERS, INC. PROFIT SHARING PLAN [EIN = 521089829]
• GROUP INSURANCE TRUST OF THE CALIFORNIA SOCIETY OF CERTIFIED PUBLIC ACCOUNTANTS 401K [EIN = 942767563]
• GROUP INSURANCE PROGRAM FOR HOURLY EMPLOYEES IN NEWPORT, ARKANSAS [EIN = 310946477]
• GROUP INSURANCE PROGRAM [EIN = 370602744]
• GROUP INSURANCE PLAN, CATERPILLAR, INC. [EIN = 370602744]
• GROUP INSURANCE PLAN AD&D [EIN = 261974324]
• GROUP INSURANCE PLAN [EIN = 251799439]
• GROUP INSURANCE PLAN [EIN = 410954702]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF AMPAL INC [EIN = 221840978]
• GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC [EIN = 741508677]
• GROUP INSURANCE PLAN OF ACCURIDE INTL INC & ASSOCIATED COMPANIES [EIN = 952462461]
• GROUP INSURANCE PLAN FOR ACTIVE AND RETIRED EMPLOYEES OF BERRY COLLEGE [EIN = 580566133]
• GROUP INSURANCE PLAN FOR INTERNATIONAL FLAVORS & FRAGRANCES INC. [EIN = 131432060]
• GROUP INSURANCE PLAN FOR NON-SALARIED EMPLOYEES OF CIBA SPECIALTY CHEMICALS AT TOMS RIVER, NJ [EIN = 133904291]
• GROUP INSURANCE PROGRAM FOR EMPLOYEES OF OLEAN GENERAL HOSPITAL [EIN = 160743102]
• GROUP INSURANCE FOR EMPLOYEES OF GOODWILL INDUSTRIES [EIN = 560844639]
• GROUP INSURANCE PLAN FOR THE MEMBERS OF PROFESSION HOCKEY PLAYERS ASSOCIATION/AMERICAN HOCKEY LEAGUE [EIN = 911820950]
• GROUP INSURANCE FOR ASSOCIATES OF ATLAS INDUSTRIES [EIN = 344179243]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF NATIONS FOODSERVICE, INC. [EIN = 942311759]
• GROUP INSURANCE PLAN [EIN = 134978230]
• GROUP INSURANCE FOR THE EMPLOYEES OF WOODFOLD MFG INC [EIN = 930653578]
• GROUP INSURANCE AND HEALTH BENEFITS FOR HOURLY EMPLOYEES OF GENERAL DYNAMICS, SPACE SYSTEMS DIV. [EIN = 131673581]
• GROUP INSURANCE PLAN [EIN = 141543982]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF ALBEMARLE CORPORATION [EIN = 541692118]
• GROUP INSURANCE PLAN SALARIED [EIN = 133429953]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SILVER SPRINGS CITRUS, INC. [EIN = 591149667]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF WAYTEC ELECTRONICS CORPORATION [EIN = 541425895]
• GROUP INSURANCE FOR HOULY WORKERS OF AY MCDONALD MFG CO [EIN = 420404280]
• GROUP INSURANCE PLAN [EIN = 060653264]
• GROUP INSURANCE PLAN [EIN = 132520327]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF WESTERN EXTERMINATOR COMPANY [EIN = 951716377]
• GROUP INSURANCE PL FOR BARGAINING EMPLOYEES OF UNION SWITCH [EIN = 250900465]
• GROUP INSURANCE PLAN OF ROSE HILLS [EIN = 133915765]
• GROUP INSURANCE PLAN FOR EMPLOYEES [EIN = 340562210]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF PAINTSVILLE PLANT [EIN = 250900465]
• GROUP INSURANCE PLAN OF SOUTHCO, INC. [EIN = 231287596]
• GROUP INSURANCE FOR THE EMPLOYEES OF GARAN INCORPORATED [EIN = 135665557]
• GROUP INSURANCE PLAN FOR LANE LIMITED [EIN = 200546644]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF BICKERSTAFF CLAY PRODUCTS COMPANY, INC. [EIN = 580349750]
• GROUP INSURANCE PLAN [EIN = 560117700]
• GROUP INSURANCE FOR EMPLOYEES OF LEADING TECHNOLOGIES, INC. [EIN = 510363266]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF TRINITY EPISCOPAL SCHOOL CORPORATION [EIN = 135563003]
• GROUP INSURANCE FOR EMPLOYEES OF OSG SHIP MANAGEMENT, INC. [EIN = 133589004]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF U.S. BRONZE [EIN = 221610152]
• GROUP INSURANCE PLAN HOME AIDES OF CENTRAL NEW YORK [EIN = 160916474]
• GROUP INSURANCE PLANS [EIN = 134978230]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF AETNA INC. [EIN = 232229683]
• GROUP INSURANCE PLANS OF THE COCA-COLA BOTTLERS' ASSOCIATION [EIN = 580198280]
• GROUP INSURANCE PLAN AND SECTION 125 [EIN = 592741848]
• GROUP INSURANCE PLAN, ALTERNATIVES UNLIMITED, INC. [EIN = 042587863]
• GROUP INSURANCE & HEALTH BENEFITS FOR SALARIED EMPLOYEES OF GENERAL DYNAMICS, AIR DEFENSE SYSTEMS, POMONA FACILITY [EIN = 131673581]
• GROUP INSURANCE PLAN [EIN = 930662669]
• GROUP INSURANCE PLAN [EIN = 371001726]
• GROUP INSURANCE PLAN [EIN = 481109486]
• GROUP INSURANCE BENEFITS FOR AIR WISCONSIN AIRLINES CORPORATION [EIN = 391767281]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF OFFSET PAPERBACK [EIN = 231873471]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF RUSSELECTRIC, INC. [EIN = 042278461]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF ISRAEL DISCOUNT BANK OF NEW YORK [EIN = 135596781]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF FSC II LLC [EIN = 562106089]
• GROUP INSURANCE PLAN OF MARKETING ASSOCIATES LLC [EIN = 383585841]
• GROUP INSURANCE PLAN OF HARVEY HUBBELL, INC. [EIN = 060397030]
• GROUP INSURANCE BENEFITS PLAN [EIN = 203906245]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF JAMESON HOSPITAL [EIN = 251536036]
• GROUP INSURANCE PLAN FOR RETIRED SALARIED EMPLOYEES OF HARLEY-DAVIDSON MOTOR GROUP, INC. [EIN = 391805420]
• GROUP INSURANCE & HEALTH BENEFITS FOR GENERAL DYNAMICS LAND SYSTEMS BARGAINING EMPLOYEES [EIN = 131673581]
• GROUP INSURANCE PLAN AD&D INSURANCE [EIN = 371225456]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF QC DATA LLC [EIN = 840848131]
• GROUP INSURANCE PLAN [EIN = 580190830]
• GROUP INSURANCE PLAN [EIN = 452015136]
• GROUP INSURANCE PLAN [EIN = 474779870]
• GROUP INSURANCE PLAN [EIN = 741554976]
• GROUP INSURANCE PLAN FOR RETIRED BARGAINING UNIT EMPLOYEES OF HARLEY DAVIDSON MOTOR COMPANY GROUP, INC. [EIN = 391805420]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF KNAPE AND VOGT MANUFACTURING COMPANY [EIN = 380722920]
• GROUP INSURANCE PLAN [EIN = 474779870]
• GROUP INSURANCE PLAN FOR RETAIL STORE MANAGERS OF MURPHY USA INC. [EIN = 462279221]
• GROUP INSURANCE PLAN UNDER THE AICPA GROUP INSURANCE TRUST [EIN = 456549619]
• GROUP INSURANCE PLAN FOR RETIREES OF THE WOOSTER BRUSH CO [EIN = 340628460]
• GROUP INSURANCE PLAN OF GENE B. GLICK COMPANY, INC. [EIN = 350924178]
• GROUP INSURANCE PLAN OF ELECTRO SWITCH CORP. [EIN = 042037902]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF POLAR CORP. [EIN = 043026575]
• GROUP INSURANCE TRUST (DELAWARE) - DREW MARINE GROUP, INC. [EIN = 270440420]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF I.L. LONG CONSTRUCTION COMPANY, INC. [EIN = 560860756]
• GROUP INSURANCE PLAN OF UNITED WAY OF ALLEN COUNTY, INC. [EIN = 350867932]
• GROUP INSURANCE PLAN OF KNEIBERT CLINIC [EIN = 430639459]
• GROUP INSURANCE PLAN FOR ASSOCIATES OF ATLAS INDUSTRIES, INC. [EIN = 344179243]
• GROUP INSURANCE PLAN UNITED MINE WORKERS [EIN = 592981186]
• GROUP INSURANCE FOR EMPLOYEES OF COMPOSIDIE, INC. [EIN = 251232176]
• GROUP INSURANCE FOR EMPLOYEES OF DIAGNOSTIC HYBRIDS, INC. [EIN = 311050325]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF RUBICON LLC [EIN = 720927730]
• GROUP INSURANCE BENEFITS FOR EMPLOYEES OF JAMES P. LINETTE, INC. [EIN = 581686770]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF NEC AND AFFILIATES [EIN = 200665337]
• GROUP INSURANCE PLAN [EIN = 371001725]
• GROUP INSURANCE PLAN FOR EMPLOYEES [EIN = 650019093]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SUNSHINE RESTAURANT MERGE SUB, LLC [EIN = 208952385]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF J C EHRLICH CO., INC DBA WESTERN EXTERMINATOR COMPANY [EIN = 231568350]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF K&M MACHINE - FABRICATING, INC. [EIN = 382509038]
• GROUP INSURANCE AND WELFARE PLAN [EIN = 010113635]
• GROUP INSURANCE PLAN OF THE LOXCREEN COMPANY INC. [EIN = 731578428]
• GROUP INSURANCE PLAN [EIN = 431270780]
• GROUP INSURANCE PLAN UNDER THE AICPA INSURANCE TRUST [EIN = 136076154]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF DOW JONES LO [EIN = 141513238]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF LUTHERAN HOMES OF SC, INC. [EIN = 570327887]
• GROUP INSURANCE FOR SALARIED EMPLOYEES OF BLH DIVISION [EIN = 361169950]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SABRELINER CORPORATION [EIN = 431289921]
• GROUP INSURANCE PLAN FOR SALARIED EMPLOYEES OF U.S. BRONZE [EIN = 221610152]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF CAROLINA FURNITURE WORKS INC [EIN = 570382139]
• GROUP INSURANCE PLAN OF MURPHY OIL USA, INC. [EIN = 710361522]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF U. S. ALUMINUM, INC. [EIN = 222766798]
• GROUP INSURANCE PLAN [EIN = 131432885]
• GROUP INSURANCE PLAN OF THE LOXCREEN COMPANY INC. [EIN = 570330702]
• GROUP INSURANCE PLAN FOR EMPLOYEES FORMERLY OF BASF CATALYSTS, LLC [EIN = 161090809]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES AT MCINTOSH, AL [EIN = 161090809]
• GROUP INSURANCE PLAN OF FAMILY HOME HEALTH SERVICES [EIN = 200164933]
• GROUP INSURANCE FOR HOURLY EMPLOYEES OF BLH DIVISION [EIN = 361169950]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF THE BILTRITE CORPORATION [EIN = 043031551]
• GROUP INSURANCE HOSPITAL PLAN [EIN = 591490411]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF CHINAWARE DIV [EIN = 250900465]
• GROUP INSURANCE PLAN FOR MOSES TAYLOR HOSPITAL [EIN = 240795461]
• GROUP INSURANCE PLAN [EIN = 470428274]
• GROUP INSURANCE PLAN FOR NON-SALARIED EMPLOYEES AT TOMS RIVER, NJ [EIN = 161090809]
• GROUP INSURANCE PLAN FOR EMPLOYEES AT SUPERIOR WI REFINERY [EIN = 364579817]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF NATIONAL FRICTION PRODUCTS [EIN = 251539808]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF THE COLLEGE OF WOOSTER [EIN = 340714654]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF THE AMERICAN CIVIL LIBERTIES UNION, INC. [EIN = 134921750]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF LOUISVILLE PLANT [EIN = 250900465]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF CHESEBROUGH-PONDS MANUFACTURING COMPANY [EIN = 060955014]
• GROUP INSURANCE PLAN OF SMURFIT-STONE CONT. CORP. AND ITS WHOLLY OWNED SUBSIDIARIES AND AFFILIATES [EIN = 362041256]
• GROUP INSURANCE FOR AMERICAN METALS CORPORATION VISION PLAN SERVICES [EIN = 680284528]
• GROUP INSURANCE FOR SALARIED EMPLOYEES OF CRUCIBLE INC.-STEEL PLAN [EIN = 133179229]
• GROUP INSURANCE PLAN [EIN = 520565065]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MID-STATES RUBBER PRODUCTS, INC. [EIN = 350818191]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SCHENKER, INC. [EIN = 135619239]
• GROUP INSURANCE ARRANGEMENT OF WELFARE PLANS [EIN = 465718220]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES AND RETIREES OF CHEYENNE LIGHT FUEL & POWER COMPANY [EIN = 460458824]
• GROUP INSURANCE FOR EMPLOYEES OF FUJIFILM MEDICAL SYSTEMS, USA, INC. [EIN = 132531985]
• GROUP INSURANCE PLAN FOR CONKLIN EMPLOYEES [EIN = 410754077]
• GROUP INSURANCE PROTECTION [EIN = 580813156]
• GROUP INSURANCE PLAN OF AMERICAN METALS CORPORATION [EIN = 680284528]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF ABILITIES, INC. [EIN = 111710419]
• GROUP INSURANCE PLAN FOR ELIGIBLE SALARIED EMPLOYEES OF RMI TITANIUM CO [EIN = 341913054]
• GROUP INSURANCE PLAN FOR EMPLOYEES [EIN = 590630270]
• GROUP INSURANCE FOR OTHER EMPLOYEES OF AY MCDONALD MFG CO [EIN = 421241542]
• GROUP INSURANCE PLAN [EIN = 131548339]
• GROUP INSURANCE LIFE PLAN [EIN = 911959949]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF JOSEPH DECOSIMO AND COMPANY, PLLC [EIN = 620852719]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF MIDLANTIC MACHINERY COMPANY [EIN = 134334615]
• GROUP INSURANCE PLAN AD&D [EIN = 911959949]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF IPEX, USA LLC [EIN = 561188786]
• GROUP INSURANCE FOR EMPLOYEES OF ROYAL OAK ENTERPRISES, INC. [EIN = 582498652]
• GROUP INSURANCE PLAN OF CRAFTMASTER FURNITURE, INC [EIN = 204595928]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF CIBA SPECIALTY CHEMICALS CORPORATION [EIN = 133904291]
• GROUP INSURANCE PLAN FOR THE EMPLOYEES OF K&M MACHINE - FABRICATING, INC. [EIN = 381443609]
• GROUP INSURANCE PLAN FOR EMPLOYEES AT SUPERIOR WI REFINERY [EIN = 710361522]
• GROUP INSURANCE PLAN RTI ALLOYS DIVISION CO RTI ALLOYS DIVISION [EIN = 341913054]
• GROUP INSURANCE PLAN OF THACHER PROFFITT & WOOD LLP [EIN = 135612353]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF C C MANGUM HOLDINGS INC [EIN = 560586552]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF SAMUEL, SON & CO. MIDWEST [EIN = 341152823]
• GROUP INSURANCE PLAN FOR HOURLY EMPLOYEES OF CIBA SPECIALTY CHEMICALS CORPORATION AT MCINTOSH, AL [EIN = 133904291]
• GROUP INSURANCE FOR EMPLOYEES OF LOGISTICORP, LLC [EIN = 752784011]
• GROUP INSURANCE PLAN [EIN = 752858030]
• GROUP INSURANCE PLAN OF MORRIS BEAN & COMPANY [EIN = 310510640]
• GROUP INSURANCE PLAN [EIN = 824907031]
• GROUP INSURANCE PLAN OF BRIGGS & STRATTON LLC [EIN = 852711260]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF R.E. PIERSON COMPANIES [EIN = 222269412]
• GROUP INSURANCE PLAN FOR EMPLOYEES OF THE ESAB GROUP, INC. [EIN = 840966648]
• GROUP INSURANCE PLAN FOR CERTAIN EMPLOYEES OF MCC HOLDING COMPANY LLC [EIN = 854357999]
• GROUP INSURANCE PLAN FOR RETIRED SALARIED EMPLOYEES OF HARLEY-DAVIDSON MOTOR GROUP, INC. [EIN = 391972791]
• GROUP INSURANCE PLAN FOR RETIRED BARGAINING UNIT EMPLOYEES OF HARLEY DAVIDSON MOTOR COMPANY GROUP, INC. [EIN = 391972791]