401k Plan data: KUTAK ROCK DEATH AND DISABILITY PLAN plan

KUTAK ROCK DEATH AND DISABILITY PLAN 401k Plan overview

Plan Name	KUTAK ROCK DEATH AND DISABILITY PLAN
Plan identification number	501

KUTAK ROCK DEATH AND DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KUTAK ROCK LLP has sponsored the creation of one or more 401k plans.

Company Name: KUTAK ROCK LLP

Employer identification number (EIN): 470597598

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Additional information about KUTAK ROCK LLP

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 1147245

More information about KUTAK ROCK LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KUTAK ROCK DEATH AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2018-01-01 FRED M. CLINGMAN FRED M. CLINGMAN 2019-07-15
501 2017-01-01 FRED M. CLINGMAN FRED M. CLINGMAN 2018-07-24
501 2016-01-01 FRED M. CLINGMAN FRED M. CLINGMAN 2017-07-25
501 2015-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2016-07-21
501 2014-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2015-07-22
501 2013-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2014-07-22
501 2012-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2013-07-24
501 2011-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2012-10-04
501 2010-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2011-07-27
501 2009-01-01 FRED M. CLINGMAN DAVID A. JACOBSON 2010-09-24

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01
501	2018-01-01	FRED M. CLINGMAN	FRED M. CLINGMAN	2019-07-15
501	2017-01-01	FRED M. CLINGMAN	FRED M. CLINGMAN	2018-07-24
501	2016-01-01	FRED M. CLINGMAN	FRED M. CLINGMAN	2017-07-25
501	2015-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2016-07-21
501	2014-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2015-07-22
501	2013-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2014-07-22
501	2012-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2013-07-24
501	2011-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2012-10-04
501	2010-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2011-07-27
501	2009-01-01	FRED M. CLINGMAN	DAVID A. JACOBSON	2010-09-24

Plan Statistics for KUTAK ROCK DEATH AND DISABILITY PLAN

401k plan membership statisitcs for KUTAK ROCK DEATH AND DISABILITY PLAN

Measure Date Value
2019: KUTAK ROCK DEATH AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 916
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 930
Total of all active and inactive participants 2019-01-01 930
2018: KUTAK ROCK DEATH AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 882
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 914
Total of all active and inactive participants 2018-01-01 914
2017: KUTAK ROCK DEATH AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 868
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 884
Total of all active and inactive participants 2017-01-01 884
2016: KUTAK ROCK DEATH AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 867
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 867
Total of all active and inactive participants 2016-01-01 867
2015: KUTAK ROCK DEATH AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 865
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 865
Total of all active and inactive participants 2015-01-01 865
2014: KUTAK ROCK DEATH AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 857
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 868
Total of all active and inactive participants 2014-01-01 868
2013: KUTAK ROCK DEATH AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 808
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 849
Total of all active and inactive participants 2013-01-01 849
2012: KUTAK ROCK DEATH AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 775
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 804
Total of all active and inactive participants 2012-01-01 804
2011: KUTAK ROCK DEATH AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 746
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 770
Total of all active and inactive participants 2011-01-01 770
2010: KUTAK ROCK DEATH AND DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 729
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 746
Total of all active and inactive participants 2010-01-01 746
2009: KUTAK ROCK DEATH AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 781
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 729
Total of all active and inactive participants 2009-01-01 729

Measure	Date	Value
2019: KUTAK ROCK DEATH AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	916
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	930
Total of all active and inactive participants	2019-01-01	930
2018: KUTAK ROCK DEATH AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	882
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	914
Total of all active and inactive participants	2018-01-01	914
2017: KUTAK ROCK DEATH AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	868
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	884
Total of all active and inactive participants	2017-01-01	884
2016: KUTAK ROCK DEATH AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	867
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	867
Total of all active and inactive participants	2016-01-01	867
2015: KUTAK ROCK DEATH AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	865
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	865
Total of all active and inactive participants	2015-01-01	865
2014: KUTAK ROCK DEATH AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	857
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	868
Total of all active and inactive participants	2014-01-01	868
2013: KUTAK ROCK DEATH AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	808
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	849
Total of all active and inactive participants	2013-01-01	849
2012: KUTAK ROCK DEATH AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	775
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	804
Total of all active and inactive participants	2012-01-01	804
2011: KUTAK ROCK DEATH AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	746
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	770
Total of all active and inactive participants	2011-01-01	770
2010: KUTAK ROCK DEATH AND DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	729
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	746
Total of all active and inactive participants	2010-01-01	746
2009: KUTAK ROCK DEATH AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	781
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	729
Total of all active and inactive participants	2009-01-01	729

Form 5500 Responses for KUTAK ROCK DEATH AND DISABILITY PLAN

2019: KUTAK ROCK DEATH AND DISABILITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: KUTAK ROCK DEATH AND DISABILITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: KUTAK ROCK DEATH AND DISABILITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: KUTAK ROCK DEATH AND DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: KUTAK ROCK DEATH AND DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: KUTAK ROCK DEATH AND DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: KUTAK ROCK DEATH AND DISABILITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KUTAK ROCK DEATH AND DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: KUTAK ROCK DEATH AND DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: KUTAK ROCK DEATH AND DISABILITY PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: KUTAK ROCK DEATH AND DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

953182

Policy instance

Insurance contract or identification number	953182
Number of Individuals Covered	352
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $420,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

953183

Policy instance

Insurance contract or identification number	953183
Number of Individuals Covered	838
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $219,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	863
Insurance policy start date	2018-10-01
Insurance policy end date	2019-10-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $567,432
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	805
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,879
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	349
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $346,094
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	823
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	847
Insurance policy start date	2017-10-01
Insurance policy end date	2018-10-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $588,107
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	813
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $76,420
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	353
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $371,157
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	790
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	813
Insurance policy start date	2016-10-01
Insurance policy end date	2017-10-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $582,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	773
Insurance policy start date	2014-10-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,925
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $565,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2925
Additional information about fees paid to insurance broker	PERSISTENCY BONUS
Insurance broker organization code?	0
Insurance broker name	ACTUARIAL CONSULTING SERVICES

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

Policy contract number

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	772
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $113,361
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	345
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,601
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	847
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $85,379
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	328
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $316,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	806
Insurance policy start date	2013-10-01
Insurance policy end date	2014-10-01
Total amount of commissions paid to insurance broker	USD $0
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $595,455
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	781
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,908
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	853
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $78,283
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	828
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $73,720
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	313
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 $300,234
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	763
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 $99,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	773
Insurance policy start date	2012-10-01
Insurance policy end date	2013-10-01
Total amount of commissions paid to insurance broker	USD $0
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $466,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	732
Insurance policy start date	2011-10-01
Insurance policy end date	2012-10-01
Total amount of commissions paid to insurance broker	USD $0
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $471,489
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	720
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 $91,803
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	297
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 $281,277
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	783
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $69,951
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

FLX963857

Policy instance

Insurance contract or identification number	FLX963857
Number of Individuals Covered	268
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,629
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 $241,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	707
Insurance policy start date	2010-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $0
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $442,594
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

FLX963863

Policy instance

Insurance contract or identification number	FLX963863
Number of Individuals Covered	689
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,116
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 $78,483
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 965491

Policy instance

Insurance contract or identification number	OK 965491
Number of Individuals Covered	748
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $916
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $59,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5091398

Policy instance

Insurance contract or identification number	GTU 5091398
Number of Individuals Covered	706
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $32,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5091399

Policy instance

Insurance contract or identification number	GTU 5091399
Number of Individuals Covered	465
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

316782

Policy instance

Insurance contract or identification number	316782
Number of Individuals Covered	693
Insurance policy start date	2009-10-01
Insurance policy end date	2010-10-01
Total amount of commissions paid to insurance broker	USD $12,063
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $472,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,063
Insurance broker organization code?	3
Insurance broker name	YEUTTER BENEFITS MANAGEMENT COMPANY

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

Policy contract number

65129

Policy instance

Insurance contract or identification number	65129
Number of Individuals Covered	654
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

112424

Policy instance

Insurance contract or identification number	112424
Number of Individuals Covered	233
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $313,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	KUTAK ROCK LLP
Employer identification number (EIN):	470597598
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	1147245