401k Plan data: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN plan

FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN
Plan identification number	501

FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN Benefits

401k Plan Type
Plan Features/Benefits

401k Sponsoring company profile

FIRST COMMUNITY CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name: FIRST COMMUNITY CREDIT UNION

Employer identification number (EIN): 430687711

NAIC Classification: 522130
NAIC Description: Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-09-01 JULIE CARMODY 2023-01-25
501 2020-09-01 KRISTIN BLAND 2022-05-17
501 2019-09-01 KRISTIN BLAND 2021-03-17
501 2018-09-01 KRISTIN BLAND 2020-01-31
501 2017-09-01
501 2016-09-01
501 2015-09-01
501 2014-09-01 KRISTEN BLAND KRISTEN BLAND 2016-02-17
501 2013-09-01 ANN KLUGESHERZ
501 2012-09-01 ANN KLUGESHERZ
501 2011-09-01 ANN KLUGESHERZ
501 2010-09-01 ANN KLUGESHERZ
501 2009-09-01 ANN KLUGESHERZ

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-09-01	JULIE CARMODY	2023-01-25
501	2020-09-01	KRISTIN BLAND	2022-05-17
501	2019-09-01	KRISTIN BLAND	2021-03-17
501	2018-09-01	KRISTIN BLAND	2020-01-31
501	2017-09-01
501	2016-09-01
501	2015-09-01
501	2014-09-01	KRISTEN BLAND		KRISTEN BLAND	2016-02-17
501	2013-09-01	ANN KLUGESHERZ
501	2012-09-01	ANN KLUGESHERZ
501	2011-09-01	ANN KLUGESHERZ
501	2010-09-01	ANN KLUGESHERZ
501	2009-09-01	ANN KLUGESHERZ

Plan Statistics for FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN

401k plan membership statisitcs for FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN

Measure Date Value
2021: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 663
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 621
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 621
Number of employers contributing to the scheme 2021-09-01 0
2020: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 587
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 613
Number of retired or separated participants receiving benefits 2020-09-01 35
Number of other retired or separated participants entitled to future benefits 2020-09-01 15
Total of all active and inactive participants 2020-09-01 663
Number of employers contributing to the scheme 2020-09-01 0
2019: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 578
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 587
Number of retired or separated participants receiving benefits 2019-09-01 0
Number of other retired or separated participants entitled to future benefits 2019-09-01 0
Total of all active and inactive participants 2019-09-01 587
Number of employers contributing to the scheme 2019-09-01 0
2018: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-09-01 545
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 578
Number of retired or separated participants receiving benefits 2018-09-01 0
Number of other retired or separated participants entitled to future benefits 2018-09-01 0
Total of all active and inactive participants 2018-09-01 578
Number of employers contributing to the scheme 2018-09-01 0
2017: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 531
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 545
Number of retired or separated participants receiving benefits 2017-09-01 1
Number of other retired or separated participants entitled to future benefits 2017-09-01 0
Total of all active and inactive participants 2017-09-01 546
Number of employers contributing to the scheme 2017-09-01 0
2016: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 518
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 531
Number of retired or separated participants receiving benefits 2016-09-01 0
Number of other retired or separated participants entitled to future benefits 2016-09-01 0
Total of all active and inactive participants 2016-09-01 531
2015: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 635
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 661
Total of all active and inactive participants 2015-09-01 661
2014: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 580
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 635
Total of all active and inactive participants 2014-09-01 635
Total participants 2014-09-01 635
2013: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 414
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 580
Total of all active and inactive participants 2013-09-01 580
Total participants 2013-09-01 0
2012: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 412
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 414
Total of all active and inactive participants 2012-09-01 414
Total participants 2012-09-01 0
2011: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 412
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 412
Total of all active and inactive participants 2011-09-01 412
Total participants 2011-09-01 412
2010: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 450
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 412
Total of all active and inactive participants 2010-09-01 412
Total participants 2010-09-01 412
2009: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 386
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 450
Total of all active and inactive participants 2009-09-01 450
Total participants 2009-09-01 450

Measure	Date	Value
2021: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	663
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	621
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	621
Number of employers contributing to the scheme	2021-09-01	0
2020: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	587
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	613
Number of retired or separated participants receiving benefits	2020-09-01	35
Number of other retired or separated participants entitled to future benefits	2020-09-01	15
Total of all active and inactive participants	2020-09-01	663
Number of employers contributing to the scheme	2020-09-01	0
2019: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	578
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	587
Number of retired or separated participants receiving benefits	2019-09-01	0
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	587
Number of employers contributing to the scheme	2019-09-01	0
2018: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	545
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	578
Number of retired or separated participants receiving benefits	2018-09-01	0
Number of other retired or separated participants entitled to future benefits	2018-09-01	0
Total of all active and inactive participants	2018-09-01	578
Number of employers contributing to the scheme	2018-09-01	0
2017: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	531
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	545
Number of retired or separated participants receiving benefits	2017-09-01	1
Number of other retired or separated participants entitled to future benefits	2017-09-01	0
Total of all active and inactive participants	2017-09-01	546
Number of employers contributing to the scheme	2017-09-01	0
2016: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	518
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	531
Number of retired or separated participants receiving benefits	2016-09-01	0
Number of other retired or separated participants entitled to future benefits	2016-09-01	0
Total of all active and inactive participants	2016-09-01	531
2015: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	635
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	661
Total of all active and inactive participants	2015-09-01	661
2014: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	580
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	635
Total of all active and inactive participants	2014-09-01	635
Total participants	2014-09-01	635
2013: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	414
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	580
Total of all active and inactive participants	2013-09-01	580
Total participants	2013-09-01	0
2012: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	412
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	414
Total of all active and inactive participants	2012-09-01	414
Total participants	2012-09-01	0
2011: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	412
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	412
Total of all active and inactive participants	2011-09-01	412
Total participants	2011-09-01	412
2010: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	450
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	412
Total of all active and inactive participants	2010-09-01	412
Total participants	2010-09-01	412
2009: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	386
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	450
Total of all active and inactive participants	2009-09-01	450
Total participants	2009-09-01	450

Form 5500 Responses for FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN

2021: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2018: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Submission has been amended	Yes
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: FIRST COMMUNITY CREDIT UNION HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

10255360

Policy instance

Insurance contract or identification number	10255360
Number of Individuals Covered	621
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $40,863
Total amount of fees paid to insurance company	USD $13,290
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $269,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,863
Amount paid for insurance broker fees	13290
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	418
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,840
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,840
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19882000

Policy instance

Insurance contract or identification number	19882000
Number of Individuals Covered	915
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $15,405
Total amount of fees paid to insurance company	USD $769
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $309,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,405
Amount paid for insurance broker fees	769
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

925023

Policy instance

Insurance contract or identification number	925023
Number of Individuals Covered	615
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $116,348
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,399,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	92601
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

W61428

Policy instance

Insurance contract or identification number	W61428
Number of Individuals Covered	799
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $97,319
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,934,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97,319
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19882000

Policy instance

Insurance contract or identification number	19882000
Number of Individuals Covered	881
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $15,129
Total amount of fees paid to insurance company	USD $740
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,129
Amount paid for insurance broker fees	740
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

10255360

Policy instance

Insurance contract or identification number	10255360
Number of Individuals Covered	613
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $38,346
Total amount of fees paid to insurance company	USD $10,244
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $250,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,346
Amount paid for insurance broker fees	10244
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	406
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $1,773
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,773
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	376
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $464
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $464
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

10255360

Policy instance

Insurance contract or identification number	10255360
Number of Individuals Covered	587
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $36,041
Total amount of fees paid to insurance company	USD $10,107
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $235,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,041
Amount paid for insurance broker fees	10107
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19882000

Policy instance

Insurance contract or identification number	19882000
Number of Individuals Covered	828
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $14,490
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,490
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

254058

Policy instance

Insurance contract or identification number	254058
Number of Individuals Covered	751
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $78,167
Total amount of fees paid to insurance company	USD $8,730
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,389,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,167
Amount paid for insurance broker fees	8730
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19882000

Policy instance

Insurance contract or identification number	19882000
Number of Individuals Covered	800
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $12,790
Total amount of fees paid to insurance company	USD $739
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $302,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,790
Amount paid for insurance broker fees	739
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

254058

Policy instance

Insurance contract or identification number	254058
Number of Individuals Covered	715
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $69,949
Total amount of fees paid to insurance company	USD $10,206
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,055,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,949
Amount paid for insurance broker fees	10206
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	351
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $1,647
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,647
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

874612G

Policy instance

Insurance contract or identification number	874612G
Number of Individuals Covered	578
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $22,559
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $225,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,559
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

908849

Policy instance

Insurance contract or identification number	908849
Number of Individuals Covered	690
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $70,402
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,816,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	70402
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	318
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $1,469
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,469
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

874612G

Policy instance

Insurance contract or identification number	874612G
Number of Individuals Covered	550
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $20,288
Total amount of fees paid to insurance company	USD $1,000
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $204,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,287
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	HOLMES MURPHY AND ASSOCIATES, INC.

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19882000

Policy instance

Insurance contract or identification number	19882000
Number of Individuals Covered	759
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $11,969
Total amount of fees paid to insurance company	USD $3,381
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $262,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,969
Amount paid for insurance broker fees	3381
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

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

Policy contract number

874612G

Policy instance

Insurance contract or identification number	874612G
Number of Individuals Covered	1004
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $13,902
Total amount of fees paid to insurance company	USD $481
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADDE-BAS & SUPP, LIFE S DEP,
Welfare Benefit Premiums Paid to Carrier	USD $132,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,898
Amount paid for insurance broker fees	481
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	258
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $1,265
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,265
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES, LLC

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

00172963

Policy instance

Insurance contract or identification number	00172963
Number of Individuals Covered	581
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $52,409
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,594,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,421
Insurance broker organization code?	3
Insurance broker name	HOLMES-MURPHY & ASSOC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19881000

Policy instance

Insurance contract or identification number	19881000
Number of Individuals Covered	661
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $11,374
Total amount of fees paid to insurance company	USD $864
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $230,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,374
Amount paid for insurance broker fees	864
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	220
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $704
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	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 $18,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $704
Insurance broker organization code?	3
Insurance broker name	USI MIDWEST

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19881000

Policy instance

Insurance contract or identification number	19881000
Number of Individuals Covered	635
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $8,227
Total amount of fees paid to insurance company	USD $886
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 $165,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,300
Amount paid for insurance broker fees	886
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

00172963

Policy instance

Insurance contract or identification number	00172963
Number of Individuals Covered	529
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $49,748
Total amount of fees paid to insurance company	USD $7,163
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 $2,382,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,896
Insurance broker organization code?	3
Amount paid for insurance broker fees	7163
Additional information about fees paid to insurance broker	BONUS INCENTIVE
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

874612G

Policy instance

Insurance contract or identification number	874612G
Number of Individuals Covered	475
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $11,408
Total amount of fees paid to insurance company	USD $2,990
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD-BAS & SUPP, LIFE S DEP
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 $133,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,135
Insurance broker organization code?	3
Amount paid for insurance broker fees	2990
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	HOLMES MURPHY & ASSOCIATES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	121
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $826
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $826
Insurance broker name	HOLMES MURPHY & ASSOCIATES, INC.

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

Policy contract number

553879

Policy instance

Insurance contract or identification number	553879
Number of Individuals Covered	434
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,647
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 $2,647
Additional information about fees paid to insurance broker	VOLUME INCENTIVES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY AND ASSOC

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

Policy contract number

712524

Policy instance

Insurance contract or identification number	712524
Number of Individuals Covered	489
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $-5
Total amount of fees paid to insurance company	USD $49,429
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,227,396
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
Amount paid for insurance broker fees	49429
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

19881000

Policy instance

Insurance contract or identification number	19881000
Number of Individuals Covered	580
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $5,306
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,306
Insurance broker name	HOLMES MURPHY & ASSOCIATES, INC.

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

Policy contract number

712524

Policy instance

Insurance contract or identification number	712524
Number of Individuals Covered	412
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $38,806
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,135,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,806
Insurance broker organization code?	3
Insurance broker name	HOLMES-MURPHY & ASSOC

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

Policy contract number

553879

Policy instance

Insurance contract or identification number	553879
Number of Individuals Covered	414
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $8,890
Total amount of fees paid to insurance company	USD $843
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,890
Amount paid for insurance broker fees	843
Additional information about fees paid to insurance broker	VOLUME INCENTIVES PAID
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY AND ASSOC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	102
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $759
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $759
Insurance broker name	HOLMES MURPHY & ASSOCIATES, INC.

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

Policy contract number

553879

Policy instance

Insurance contract or identification number	553879
Number of Individuals Covered	386
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $11,180
Total amount of fees paid to insurance company	USD $567
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30029458

Policy instance

Insurance contract or identification number	30029458
Number of Individuals Covered	55
Insurance policy start date	2012-01-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $342
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,423
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

712524

Policy instance

Insurance contract or identification number	712524
Number of Individuals Covered	412
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $40,426
Total amount of fees paid to insurance company	USD $10,093
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,870,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

553879

Policy instance

Insurance contract or identification number	553879
Number of Individuals Covered	371
Insurance policy start date	2011-01-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $3,491
Total amount of fees paid to insurance company	USD $40
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

553879

Policy instance

Insurance contract or identification number	553879
Number of Individuals Covered	365
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,741
Total amount of fees paid to insurance company	USD $1,029
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,615
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

712524

Policy instance

Insurance contract or identification number	712524
Number of Individuals Covered	412
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $47,002
Total amount of fees paid to insurance company	USD $20,020
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,718,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FIRST COMMUNITY CREDIT UNION
Employer identification number (EIN):	430687711
NAIC Classification:	522130
NAIC Description:	Credit Unions