401k Plan data: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN plan

TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 401k Plan overview

Plan Name	TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN
Plan identification number	501

TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

TREAT AMERICA FOOD SERVICES has sponsored the creation of one or more 401k plans.

Company Name: TREAT AMERICA FOOD SERVICES

Employer identification number (EIN): 481206149

NAIC Classification: 722300
NAIC Description: Special Food Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TREAT AMERICA FOOD SERVICES GROUP MEDICAL 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
501 2017-01-01 LARRY WEINSTEIN
501 2016-01-01 LARRY WEINSTEIN
501 2015-01-01 LARRY WEINSTEIN
501 2014-01-01 LARRY WEINSTEIN
501 2013-01-01 LARRY WEINSTEIN
501 2012-01-01 LARRY WEINSTEIN
501 2011-01-01 TRACIE DYE
501 2010-01-01 TRACIE DYE

Plan Statistics for TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN

401k plan membership statisitcs for TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN

Measure Date Value
2019: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 458
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
2018: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 535
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 458
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 458
2017: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 527
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 535
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 535
2016: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 889
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 527
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 527
2015: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 861
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 886
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 889
2014: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 791
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 856
Number of retired or separated participants receiving benefits 2014-01-01 5
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 861
2013: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 849
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 791
Total of all active and inactive participants 2013-01-01 791
2012: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 877
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 849
Total of all active and inactive participants 2012-01-01 849
2011: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 835
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 877
Total of all active and inactive participants 2011-01-01 877
2010: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 531
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 835
Total of all active and inactive participants 2010-01-01 835

Measure	Date	Value
2019: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	458
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
2018: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	535
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	458
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	458
2017: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	527
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	535
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	535
2016: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	889
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	527
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	527
2015: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	861
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	886
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	889
2014: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	791
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	856
Number of retired or separated participants receiving benefits	2014-01-01	5
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	861
2013: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	849
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	791
Total of all active and inactive participants	2013-01-01	791
2012: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	877
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	849
Total of all active and inactive participants	2012-01-01	849
2011: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	835
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	877
Total of all active and inactive participants	2011-01-01	877
2010: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	531
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	835
Total of all active and inactive participants	2010-01-01	835

Form 5500 Responses for TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN

2019: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: TREAT AMERICA FOOD SERVICES GROUP MEDICAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: TREAT AMERICA FOOD SERVICES GROUP MEDICAL 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 funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52451

Policy instance

Insurance contract or identification number	52451
Number of Individuals Covered	273
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,141
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,141
Insurance broker organization code?	3

LIBERTY INSURANCE UNDERWRITERS, INC. (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

TRU0000026-02

Policy instance

Insurance contract or identification number	TRU0000026-02
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $893,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

08995

Policy instance

Insurance contract or identification number	08995
Number of Individuals Covered	425
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $82,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787104

Policy instance

Insurance contract or identification number	E7787104
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $717
Total amount of fees paid to insurance company	USD $12
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $8,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $615
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	FEES

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	118
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,246
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,246
Insurance broker organization code?	3

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	305
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,722
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,722
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787013

Policy instance

Insurance contract or identification number	E7787013
Number of Individuals Covered	16
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,278
Total amount of fees paid to insurance company	USD $45
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $11,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,084
Amount paid for insurance broker fees	2
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5931444

Policy instance

Insurance contract or identification number	5931444
Number of Individuals Covered	193
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,342
Total amount of fees paid to insurance company	USD $171
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,342
Amount paid for insurance broker fees	171
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

08995A

Policy instance

Insurance contract or identification number	08995A
Number of Individuals Covered	240
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $103,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

08995D

Policy instance

Insurance contract or identification number	08995D
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52451

Policy instance

Insurance contract or identification number	52451
Number of Individuals Covered	354
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,195
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,195
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

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

Policy contract number

08995

Policy instance

Insurance contract or identification number	08995
Number of Individuals Covered	535
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $96,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

69858-0

Policy instance

Insurance contract or identification number	69858-0
Number of Individuals Covered	456
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $33,772
Total amount of fees paid to insurance company	USD $34,590
Welfare Benefit Premiums Paid to Carrier	USD $691,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,772
Amount paid for insurance broker fees	34590
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05931444

Policy instance

Insurance contract or identification number	KM05931444
Number of Individuals Covered	286
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,135
Total amount of fees paid to insurance company	USD $4,189
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $40,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,135
Amount paid for insurance broker fees	4189
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CREATIVE PLANNING BENEFITS LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787104

Policy instance

Insurance contract or identification number	E7787104
Number of Individuals Covered	20
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,313
Total amount of fees paid to insurance company	USD $34
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $8,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,166
Insurance broker organization code?	3
Amount paid for insurance broker fees	22
Additional information about fees paid to insurance broker	FEES
Insurance broker name	RYAN BOWLING

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	136
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,356
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,356
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	359
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,048
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,048
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787013

Policy instance

Insurance contract or identification number	E7787013
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,075
Total amount of fees paid to insurance company	USD $21
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $10,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $942
Insurance broker organization code?	3
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	FEES
Insurance broker name	RYAN BOWLING

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

Policy contract number

08995A

Policy instance

Insurance contract or identification number	08995A
Number of Individuals Covered	286
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $103,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

08995D

Policy instance

Insurance contract or identification number	08995D
Number of Individuals Covered	4
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52451

Policy instance

Insurance contract or identification number	52451
Number of Individuals Covered	319
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,619
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,619
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787013

Policy instance

Insurance contract or identification number	E7787013
Number of Individuals Covered	19
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $794
Total amount of fees paid to insurance company	USD $23
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $7,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $686
Insurance broker organization code?	3
Amount paid for insurance broker fees	8
Additional information about fees paid to insurance broker	FEES
Insurance broker name	RYAN BOWLING

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
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 $5,015
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,015
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

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

Policy contract number

698213G

Policy instance

Insurance contract or identification number	698213G
Number of Individuals Covered	255
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,609
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,609
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	148
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,283
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,283
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	725
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $91
Welfare Benefit Premiums Paid to Carrier	USD $785,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GL/GH/GI-8995

Policy instance

Insurance contract or identification number	GL/GH/GI-8995
Number of Individuals Covered	886
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $198,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787104

Policy instance

Insurance contract or identification number	E7787104
Number of Individuals Covered	20
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,753
Total amount of fees paid to insurance company	USD $97
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $7,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,562
Insurance broker organization code?	3
Amount paid for insurance broker fees	34
Additional information about fees paid to insurance broker	FEES
Insurance broker name	RYAN BOWLING

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	683
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,637
Welfare Benefit Premiums Paid to Carrier	USD $711,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,637
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GL/GH/GI-8995

Policy instance

Insurance contract or identification number	GL/GH/GI-8995
Number of Individuals Covered	856
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,205
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $203,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,205
Insurance broker organization code?	3
Insurance broker name	RICHARD KAHLE

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,353
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,353
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	331
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,798
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,798
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

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

Policy contract number

698213G

Policy instance

Insurance contract or identification number	698213G
Number of Individuals Covered	266
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,226
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,226
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787104

Policy instance

Insurance contract or identification number	E7787104
Number of Individuals Covered	18
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,184
Total amount of fees paid to insurance company	USD $46
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $9,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,041
Amount paid for insurance broker fees	4
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	RYAN BOWLING

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787103

Policy instance

Insurance contract or identification number	E7787103
Number of Individuals Covered	16
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,025
Total amount of fees paid to insurance company	USD $38
Other welfare benefits provided	VOL. PRODUCTS:HOSPITAL/CRITICAL ILL
Welfare Benefit Premiums Paid to Carrier	USD $8,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $899
Amount paid for insurance broker fees	3
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	RYAN BOWLING

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52451

Policy instance

Insurance contract or identification number	52451
Number of Individuals Covered	308
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,874
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,874
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	741
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $35,345
Welfare Benefit Premiums Paid to Carrier	USD $651,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,345
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GL/GW/GD-8995

Policy instance

Insurance contract or identification number	GL/GW/GD-8995
Number of Individuals Covered	791
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $22,966
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $229,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,966
Insurance broker organization code?	3
Insurance broker name	RICHARD KAHLE

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7787104

Policy instance

Insurance contract or identification number	E7787104
Number of Individuals Covered	21
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,368
Total amount of fees paid to insurance company	USD $218
Other welfare benefits provided	VOL. PRODUCTS: HOSPITAL/CRITICAL IL
Welfare Benefit Premiums Paid to Carrier	USD $13,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,109
Amount paid for insurance broker fees	138
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	RON BOWLING

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52451

Policy instance

Insurance contract or identification number	52451
Number of Individuals Covered	366
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,041
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,041
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	160
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,366
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,366
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

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

Policy contract number

698213G

Policy instance

Insurance contract or identification number	698213G
Number of Individuals Covered	290
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,452
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,452
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

52450

Policy instance

Insurance contract or identification number	52450
Number of Individuals Covered	357
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,094
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,094
Insurance broker organization code?	3
Insurance broker name	JERI GLOE

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	769
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $32,937
Welfare Benefit Premiums Paid to Carrier	USD $554,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,937
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-028992

Policy instance

Insurance contract or identification number	010-028992
Number of Individuals Covered	1856
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,508
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,508
Insurance broker organization code?	3
Insurance broker name	GLOE, JERI , M.

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

Policy contract number

GL/GW/GD-8995

Policy instance

Insurance contract or identification number	GL/GW/GD-8995
Number of Individuals Covered	849
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,836
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $228,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,836
Insurance broker organization code?	3
Insurance broker name	RICHARD KAHLE

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	822
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $33,258
Welfare Benefit Premiums Paid to Carrier	USD $510,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

1234

Policy instance

Insurance contract or identification number	1234
Number of Individuals Covered	877
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $37,254
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $248,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-028992

Policy instance

Insurance contract or identification number	010-028992
Number of Individuals Covered	1821
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,490
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

1234

Policy instance

Insurance contract or identification number	1234
Number of Individuals Covered	835
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $37,273
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $248,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,273
Insurance broker organization code?	3
Insurance broker name	RICHARD KAHLE

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-028992

Policy instance

Insurance contract or identification number	010-028992
Number of Individuals Covered	1726
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,395
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $264,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,395
Insurance broker organization code?	3
Insurance broker name	GLOE, JERI , M.

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3215708

Policy instance

Insurance contract or identification number	3215708
Number of Individuals Covered	791
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $59,629
Welfare Benefit Premiums Paid to Carrier	USD $457,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,629
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	TREAT AMERICA FOOD SERVICES
Employer identification number (EIN):	481206149
NAIC Classification:	722300
NAIC Description:	Special Food Services