401k Plan data: TELLIGEN WELFARE PLAN plan

TELLIGEN WELFARE PLAN 401k Plan overview

Plan Name	TELLIGEN WELFARE PLAN
Plan identification number	502

TELLIGEN WELFARE PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: TELLIGEN, INC.

Employer identification number (EIN): 420992483

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Additional information about TELLIGEN, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 2013-12-13

Company Identification Number: 469256

Legal Registered Office Address: 505 5TH AVENUE
SUITE 729
DES MOINES
United States of America (USA)
50309

More information about TELLIGEN, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TELLIGEN WELFARE PLAN

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

Plan Statistics for TELLIGEN WELFARE PLAN

401k plan membership statisitcs for TELLIGEN WELFARE PLAN

Measure Date Value
2022: TELLIGEN WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 605
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 603
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 603
2021: TELLIGEN WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 623
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 601
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 605
2020: TELLIGEN WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 693
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 611
Number of retired or separated participants receiving benefits 2020-01-01 12
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 623
2019: TELLIGEN WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 721
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 683
Number of retired or separated participants receiving benefits 2019-01-01 10
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 693
2018: TELLIGEN WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 756
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 715
Number of retired or separated participants receiving benefits 2018-01-01 7
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 722
2017: TELLIGEN WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 692
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 748
Number of retired or separated participants receiving benefits 2017-01-01 10
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 758
2016: TELLIGEN WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 570
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 692
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 692
2015: TELLIGEN WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 560
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 570
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 570
2014: TELLIGEN WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 520
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 560
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 560
2013: TELLIGEN WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 532
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 520
Total of all active and inactive participants 2013-01-01 520
2012: TELLIGEN WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 535
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 532
Total of all active and inactive participants 2012-01-01 532
2011: TELLIGEN WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 608
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 535
Total of all active and inactive participants 2011-01-01 535
2009: TELLIGEN WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 754
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 615
Total of all active and inactive participants 2009-01-01 615

Measure	Date	Value
2022: TELLIGEN WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	605
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	603
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	603
2021: TELLIGEN WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	623
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	601
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	605
2020: TELLIGEN WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	693
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	611
Number of retired or separated participants receiving benefits	2020-01-01	12
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	623
2019: TELLIGEN WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	721
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	683
Number of retired or separated participants receiving benefits	2019-01-01	10
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	693
2018: TELLIGEN WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	756
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	715
Number of retired or separated participants receiving benefits	2018-01-01	7
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	722
2017: TELLIGEN WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	692
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	748
Number of retired or separated participants receiving benefits	2017-01-01	10
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	758
2016: TELLIGEN WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	570
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	692
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	692
2015: TELLIGEN WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	560
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	570
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	570
2014: TELLIGEN WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	520
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	560
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	560
2013: TELLIGEN WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	532
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	520
Total of all active and inactive participants	2013-01-01	520
2012: TELLIGEN WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	535
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	532
Total of all active and inactive participants	2012-01-01	532
2011: TELLIGEN WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	608
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	535
Total of all active and inactive participants	2011-01-01	535
2009: TELLIGEN WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	754
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	615
Total of all active and inactive participants	2009-01-01	615

Form 5500 Responses for TELLIGEN WELFARE PLAN

2022: TELLIGEN WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: TELLIGEN WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: TELLIGEN WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: TELLIGEN WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: TELLIGEN WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: TELLIGEN WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: TELLIGEN WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: TELLIGEN WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: TELLIGEN WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: TELLIGEN WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: TELLIGEN WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: TELLIGEN WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: TELLIGEN WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	This submission is the final filing	No
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

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	465
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $50,870
Total amount of fees paid to insurance company	USD $5,607
Welfare Benefit Premiums Paid to Carrier	USD $1,018,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,870
Insurance broker organization code?	3
Amount paid for insurance broker fees	5607
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	175
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,724
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $67,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,724
Insurance broker organization code?	3

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	374
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,039
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,039
Insurance broker organization code?	3

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	603
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $12,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	163
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,805
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $57,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,805
Insurance broker organization code?	3

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	478
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $34,800
Total amount of fees paid to insurance company	USD $18,270
Welfare Benefit Premiums Paid to Carrier	USD $696,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,800
Insurance broker organization code?	3
Amount paid for insurance broker fees	14115
Additional information about fees paid to insurance broker	BONUS

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	601
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $12,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	363
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,023
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,023
Insurance broker organization code?	3

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	478
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $38,476
Welfare Benefit Premiums Paid to Carrier	USD $677,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	33875
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	150
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,538
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $46,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,538
Insurance broker organization code?	3

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	385
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,972
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,972
Insurance broker organization code?	3

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	611
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $10,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	158
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,085
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $41,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,085
Insurance broker organization code?	3

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	490
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,228
Total amount of fees paid to insurance company	USD $11,475
Welfare Benefit Premiums Paid to Carrier	USD $576,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,228
Amount paid for insurance broker fees	1613
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	378
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,067
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,067
Insurance broker organization code?	3

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	683
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $11,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK 751895

Policy instance

Insurance contract or identification number	LK 751895
Number of Individuals Covered	709
Insurance policy start date	2018-01-01
Insurance policy end date	2018-04-30
Total amount of fees paid to insurance company	USD $1,535
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1535
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	714
Insurance policy start date	2018-01-01
Insurance policy end date	2018-04-30
Total amount of fees paid to insurance company	USD $2,357
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2357
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	764
Insurance policy start date	2018-01-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $383
Total amount of fees paid to insurance company	USD $587
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $11,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $383
Amount paid for insurance broker fees	587
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	690
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $11,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	531
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $25,328
Total amount of fees paid to insurance company	USD $13,833
Welfare Benefit Premiums Paid to Carrier	USD $539,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,328
Amount paid for insurance broker fees	1655
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	427
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,114
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,114
Insurance broker organization code?	3

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	119
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,799
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $35,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,799
Insurance broker organization code?	3

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	824
Insurance policy start date	2018-01-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $3,961
Total amount of fees paid to insurance company	USD $3,946
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,961
Amount paid for insurance broker fees	3946
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

LK 751895

Policy instance

Insurance contract or identification number	LK 751895
Number of Individuals Covered	741
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	811
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,258
Total amount of fees paid to insurance company	USD $501
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $36,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,258
Amount paid for insurance broker fees	501
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	746
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $1,728
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $144,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1728
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

247056

Policy instance

Insurance contract or identification number	247056
Number of Individuals Covered	611
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $42,396
Welfare Benefit Premiums Paid to Carrier	USD $501,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	25074
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	UMR, INC.

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	450
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,118
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,118
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

69750-8

Policy instance

Insurance contract or identification number	69750-8
Number of Individuals Covered	90
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,807
Other welfare benefits provided	VOLUNTARY ACCIDENT, CI AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $34,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,807
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	592
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $9,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

417004411537

Policy instance

Insurance contract or identification number	417004411537
Number of Individuals Covered	591
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Welfare Benefit Premiums Paid to Carrier	USD $502,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	847
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,471
Total amount of fees paid to insurance company	USD $3,406
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $243,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,471
Amount paid for insurance broker fees	3406
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	646
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,200
Total amount of fees paid to insurance company	USD $549
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $26,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,200
Amount paid for insurance broker fees	549
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	576
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $9,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Number of Individuals Covered	139
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,702
Total amount of fees paid to insurance company	USD $1,460
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,702
Amount paid for insurance broker fees	1460
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	671
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,664
Total amount of fees paid to insurance company	USD $3,674
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $180,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,664
Amount paid for insurance broker fees	3674
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	570
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $2,633
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2633
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

417002411537

Policy instance

Insurance contract or identification number	417002411537
Number of Individuals Covered	458
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Welfare Benefit Premiums Paid to Carrier	USD $428,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30050771

Policy instance

Insurance contract or identification number	30050771
Number of Individuals Covered	336
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,833
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,833
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Number of Individuals Covered	142
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,554
Total amount of fees paid to insurance company	USD $1,166
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	237
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,554
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	681
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,591
Total amount of fees paid to insurance company	USD $3,167
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	654
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $7,591
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	642
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $697
Total amount of fees paid to insurance company	USD $459
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $24,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	93
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $697
Insurance broker name	LOCKTON COMPANIES, LLC

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	634
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $9,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

417002411537

Policy instance

Insurance contract or identification number	417002411537
Number of Individuals Covered	413
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Welfare Benefit Premiums Paid to Carrier	USD $371,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	560
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,577
Total amount of fees paid to insurance company	USD $1,361
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	372
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,577
Insurance broker name	LOCKTON COMPANIES, LLC

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP/SAP

Policy instance

Insurance contract or identification number	EAP/SAP
Number of Individuals Covered	557
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $415
Other welfare benefits provided	EAP AND SAP
Welfare Benefit Premiums Paid to Carrier	USD $8,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $415
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	520
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,998
Total amount of fees paid to insurance company	USD $1,717
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,030
Amount paid for insurance broker fees	1717
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	971
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $21,557
Total amount of fees paid to insurance company	USD $3,036
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $187,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,186
Amount paid for insurance broker fees	3036
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Number of Individuals Covered	129
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,741
Total amount of fees paid to insurance company	USD $1,008
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,264
Amount paid for insurance broker fees	1008
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	642
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,451
Total amount of fees paid to insurance company	USD $434
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $27,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,259
Amount paid for insurance broker fees	434
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

0717481

Policy instance

Insurance contract or identification number	0717481
Number of Individuals Covered	1073
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,723
Total amount of fees paid to insurance company	USD $69,763
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,634,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-16,802
Amount paid for insurance broker fees	27938
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Number of Individuals Covered	532
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,473
Total amount of fees paid to insurance company	USD $1,880
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,473
Amount paid for insurance broker fees	1880
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

EMPLOYEE & FAMILY RESOURCES, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	557
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	EAP
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $425
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Number of Individuals Covered	988
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $23,860
Total amount of fees paid to insurance company	USD $3,259
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $159,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,860
Amount paid for insurance broker fees	3259
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Number of Individuals Covered	655
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,422
Total amount of fees paid to insurance company	USD $488
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $22,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,422
Amount paid for insurance broker fees	488
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Number of Individuals Covered	123
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,364
Total amount of fees paid to insurance company	USD $986
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,364
Amount paid for insurance broker fees	986
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

0717481

Policy instance

Insurance contract or identification number	0717481
Number of Individuals Covered	1472
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $82,383
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,443,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,383
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )

Policy contract number

92030

Policy instance

Insurance contract or identification number	92030
Number of Individuals Covered	453
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,444
Total amount of fees paid to insurance company	USD $661
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,444
Amount paid for insurance broker fees	661
Additional information about fees paid to insurance broker	SALES AND PERSISTENCY BONUS
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )

Policy contract number

92030

Policy instance

Insurance contract or identification number	92030
Number of Individuals Covered	454
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,095
Total amount of fees paid to insurance company	USD $997
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,441
Total amount of fees paid to insurance company	USD $1,943
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $28,300
Total amount of fees paid to insurance company	USD $3,300
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $188,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,257
Total amount of fees paid to insurance company	USD $503
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $28,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,520
Total amount of fees paid to insurance company	USD $919
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

717481

Policy instance

Insurance contract or identification number	717481
Number of Individuals Covered	1472
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $61,223
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,932,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 )

Policy contract number

92030

Policy instance

Insurance contract or identification number	92030
Number of Individuals Covered	570
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,264
Total amount of fees paid to insurance company	USD $1,157
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,264
Amount paid for insurance broker fees	1157
Additional information about fees paid to insurance broker	SALES AND PERSISTENCY BONUS
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

LK 961574

Policy instance

Insurance contract or identification number	LK 961574
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $21,245
Total amount of fees paid to insurance company	USD $2,192
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,245
Amount paid for insurance broker fees	2192
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

FLX962072

Policy instance

Insurance contract or identification number	FLX962072
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $35,873
Total amount of fees paid to insurance company	USD $3,674
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $239,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,873
Amount paid for insurance broker fees	3674
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

OK 963666

Policy instance

Insurance contract or identification number	OK 963666
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,489
Total amount of fees paid to insurance company	USD $557
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $36,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,489
Amount paid for insurance broker fees	557
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

VDT960355

Policy instance

Insurance contract or identification number	VDT960355
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,612
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,612
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

717481

Policy instance

Insurance contract or identification number	717481
Number of Individuals Covered	1472
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $171,881
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,446,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $171,881
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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Company Name:	TELLIGEN, INC.
Employer identification number (EIN):	420992483
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	2013-12-13
Company Identification Number:	469256
Legal Registered Office Address:	505 5TH AVENUE SUITE 729 DES MOINES United States of America (USA) 50309