THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

THE ARC OF THE CENTRAL CHESAPEAKE REGION, INC. has sponsored the creation of one or more 401k plans.

Company Name:	THE ARC OF THE CENTRAL CHESAPEAKE REGION, INC.
Employer identification number (EIN):	526047882
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01
501	2021-07-01
501	2020-07-01
501	2019-07-01	SHANNON ROSS	2021-01-26
501	2018-07-01	SHANNON ROSS	2020-01-13
501	2017-07-01
501	2016-07-01
501	2015-07-01	JEFFREY ALTHOFF
501	2014-07-01	JEFFREY ALTHOFF
501	2013-07-01	STEPHANIE BOBLITT
501	2012-07-01	STEPHANIE BOBLITT		STEPHANIE BOBLITT	2013-12-13
501	2011-07-01	STEPHANIE BOBLITT
501	2009-07-01	STEPHANIE BOBLITT

Plan Statistics for THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN

Measure	Date	Value
2022: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	349
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	439
Number of retired or separated participants receiving benefits	2022-07-01	1
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	440
2021: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	284
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	349
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	349
2020: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	258
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	284
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	284
2019: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	220
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	258
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	258
2018: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	223
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	219
Number of retired or separated participants receiving benefits	2018-07-01	1
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	220
2017: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	244
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	222
Number of retired or separated participants receiving benefits	2017-07-01	1
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	223
2016: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	256
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	243
Number of retired or separated participants receiving benefits	2016-07-01	1
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	244
2015: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	252
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	255
Number of retired or separated participants receiving benefits	2015-07-01	1
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	256
2014: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	274
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	251
Number of retired or separated participants receiving benefits	2014-07-01	1
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	252
2013: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	279
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	274
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	274
2012: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	263
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	274
Number of retired or separated participants receiving benefits	2012-07-01	5
Total of all active and inactive participants	2012-07-01	279
Total participants	2012-07-01	279
2011: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	207
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	260
Number of retired or separated participants receiving benefits	2011-07-01	3
Total of all active and inactive participants	2011-07-01	263
Total participants	2011-07-01	263
2009: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	156
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	163
Number of retired or separated participants receiving benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	164
Total participants	2009-07-01	164

Form 5500 Responses for THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN

2022: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Submission has been amended	No
2022-07-01	This submission is the final filing	No
2022-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-07-01	Plan is a collectively bargained plan	No
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: THE ARC OF THE CENTRAL CHESAPEAKE REGION HEALTH AND WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00021891
Policy instance	2
Insurance contract or identification number 00021891 Number of Individuals Covered 200 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $7,781 Total amount of fees paid to insurance company USD $2,974 Are there contracts with allocated funds for individual policies? 0 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 $97,260 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,863 Amount paid for insurance broker fees 2974 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BR4X
Policy instance	7
Insurance contract or identification number GLTD0BR4X Number of Individuals Covered 439 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $12,651 Total amount of fees paid to insurance company USD $8,889 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $84,362 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,651 Amount paid for insurance broker fees 6359 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC 0BR4X
Policy instance	6
Insurance contract or identification number GUC 0BR4X Number of Individuals Covered 134 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $7,433 Total amount of fees paid to insurance company USD $5,359 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $49,562 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,433 Amount paid for insurance broker fees 3872 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BR4X
Policy instance	5
Insurance contract or identification number GLUG0BR4X Number of Individuals Covered 439 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $5,377 Total amount of fees paid to insurance company USD $3,655 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $35,856 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,377 Amount paid for insurance broker fees 2580 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	885645G
Policy instance	4
Insurance contract or identification number 885645G Number of Individuals Covered 113 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $5,743 Total amount of fees paid to insurance company USD $3,210 Are there contracts with allocated funds for individual policies? 0 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 Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $40,133 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,743 Amount paid for insurance broker fees 3210 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
COUNTRY WIDE PREPAID LEGAL SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	N/A
Policy instance	3
Insurance contract or identification number N/A Number of Individuals Covered 44 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $537 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL SERVICES 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 $5,374 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $537 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0BR4X
Policy instance	8
Insurance contract or identification number GVTL0BR4X Number of Individuals Covered 98 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $5,328 Total amount of fees paid to insurance company USD $3,737 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $35,525 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,328 Amount paid for insurance broker fees 2671 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10290031001
Policy instance	1
Insurance contract or identification number 10290031001 Number of Individuals Covered 277 Insurance policy start date 2022-07-01 Insurance policy end date 2023-06-30 Total amount of commissions paid to insurance broker USD $2,298 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $22,150 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,768 Insurance broker organization code? 3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00021891
Policy instance	2
Insurance contract or identification number 00021891 Number of Individuals Covered 162 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $5,797 Total amount of fees paid to insurance company USD $2,373 Are there contracts with allocated funds for individual policies? 0 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 $72,345 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,617 Amount paid for insurance broker fees 2373 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10290031001
Policy instance	1
Insurance contract or identification number 10290031001 Number of Individuals Covered 200 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $2,731 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $20,626 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,101 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC 0BR4X
Policy instance	6
Insurance contract or identification number GUC 0BR4X Number of Individuals Covered 105 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $4,812 Total amount of fees paid to insurance company USD $2,949 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $32,083 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,812 Amount paid for insurance broker fees 1987 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
COUNTRY WIDE PREPAID LEGAL SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	N/A
Policy instance	3
Insurance contract or identification number N/A Number of Individuals Covered 44 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $679 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL SERVICES 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 $6,794 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $679 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	885645G
Policy instance	4
Insurance contract or identification number 885645G Number of Individuals Covered 82 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $4,483 Total amount of fees paid to insurance company USD $2,511 Are there contracts with allocated funds for individual policies? 0 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 Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY 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 $31,390 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,483 Amount paid for insurance broker fees 2511 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BR4X
Policy instance	5
Insurance contract or identification number GLUG0BR4X Number of Individuals Covered 349 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $3,805 Total amount of fees paid to insurance company USD $2,804 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $25,365 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,805 Amount paid for insurance broker fees 2043 Additional information about fees paid to insurance broker TPA FEES PAID Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BR4X
Policy instance	7
Insurance contract or identification number GLTD0BR4X Number of Individuals Covered 347 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $9,706 Total amount of fees paid to insurance company USD $7,131 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $64,708 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,706 Amount paid for insurance broker fees 5190 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0BR4X
Policy instance	8
Insurance contract or identification number GVTL0BR4X Number of Individuals Covered 76 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $3,609 Total amount of fees paid to insurance company USD $2,733 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $24,063 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,609 Amount paid for insurance broker fees 2011 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3340983
Policy instance	2
Insurance contract or identification number 3340983 Number of Individuals Covered 152 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $3,607 Total amount of fees paid to insurance company USD $89,178 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,506,646 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,607 Amount paid for insurance broker fees 57595 Additional information about fees paid to insurance broker BENEFIT ADVISOR PAYMENTS Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10290031001
Policy instance	1
Insurance contract or identification number 10290031001 Number of Individuals Covered 180 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $958 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $11,143 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $737 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC 0BR4X
Policy instance	6
Insurance contract or identification number GUC 0BR4X Number of Individuals Covered 55 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $2,481 Total amount of fees paid to insurance company USD $1,567 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,594 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,481 Amount paid for insurance broker fees 1071 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
COUNTRY WIDE PREPAID LEGAL SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	NA
Policy instance	3
Insurance contract or identification number NA Number of Individuals Covered 21 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $369 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL SERVICES Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,693 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $369 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	885645G
Policy instance	4
Insurance contract or identification number 885645G Number of Individuals Covered 90 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $2,236 Total amount of fees paid to insurance company USD $1,234 Are there contracts with allocated funds for individual policies? 0 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 Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY 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 $15,431 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,236 Amount paid for insurance broker fees 1234 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BR4X
Policy instance	5
Insurance contract or identification number GLUG0BR4X Number of Individuals Covered 284 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $3,066 Total amount of fees paid to insurance company USD $1,408 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $20,508 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,066 Amount paid for insurance broker fees 795 Additional information about fees paid to insurance broker TPA FEES PAID Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BR4X
Policy instance	7
Insurance contract or identification number GLTD0BR4X Number of Individuals Covered 284 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $7,837 Total amount of fees paid to insurance company USD $3,636 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $52,423 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,837 Amount paid for insurance broker fees 2069 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0BR4X
Policy instance	8
Insurance contract or identification number GVTL0BR4X Number of Individuals Covered 60 Insurance policy start date 2020-07-01 Insurance policy end date 2021-06-30 Total amount of commissions paid to insurance broker USD $3,331 Total amount of fees paid to insurance company USD $1,965 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $22,282 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,331 Amount paid for insurance broker fees 1299 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	DM06073801
Policy instance	1
Insurance contract or identification number DM06073801 Number of Individuals Covered 130 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $965 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $9,649 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $965 Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3340983
Policy instance	2
Insurance contract or identification number 3340983 Number of Individuals Covered 154 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $3,174 Total amount of fees paid to insurance company USD $66,174 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,477,916 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 30809 Additional information about fees paid to insurance broker GENERAL AGENT FEES Insurance broker organization code? 3 Commission paid to Insurance Broker USD $2,072
COUNTRY WIDE PREPAID LEGAL SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	NA
Policy instance	3
Insurance contract or identification number NA Number of Individuals Covered 15 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $262 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL 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 $2,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $262 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	885645G
Policy instance	4
Insurance contract or identification number 885645G Number of Individuals Covered 54 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $1,803 Total amount of fees paid to insurance company USD $988 Are there contracts with allocated funds for individual policies? 0 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 Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $12,355 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,135 Amount paid for insurance broker fees 621 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	5
Insurance contract or identification number 000010020142 Number of Individuals Covered 258 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $2,085 Total amount of fees paid to insurance company USD $1,232 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $17,780 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,473 Amount paid for insurance broker fees 993 Additional information about fees paid to insurance broker TPA FEES, OVERRRIDES, BONUS Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010214110
Policy instance	6
Insurance contract or identification number 000010214110 Number of Individuals Covered 53 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $3,577 Total amount of fees paid to insurance company USD $1,016 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $13,978 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,921 Amount paid for insurance broker fees 851 Additional information about fees paid to insurance broker TPA FEES, OVERRIDES, BONUS Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	7
Insurance contract or identification number 000010022374 Number of Individuals Covered 258 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $3,892 Total amount of fees paid to insurance company USD $3,304 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $45,517 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,040 Amount paid for insurance broker fees 2693 Additional information about fees paid to insurance broker TPA FEES, OVERRIDES, BONUS Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	8
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 57 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $3,393 Total amount of fees paid to insurance company USD $1,279 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,525 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,262 Amount paid for insurance broker fees 1041 Additional information about fees paid to insurance broker TPA FEES ($739); OVERRIDES ($302) Insurance broker organization code? 3
COUNTRY WIDE PREPAID LEGAL SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	NA
Policy instance	3
Insurance contract or identification number NA Number of Individuals Covered 20 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $576 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL 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 $2,880 Commission paid to Insurance Broker USD $576 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	885645G
Policy instance	4
Insurance contract or identification number 885645G Number of Individuals Covered 23 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $1,175 Total amount of fees paid to insurance company USD $446 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS 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 $8,252 Commission paid to Insurance Broker USD $1,175 Amount paid for insurance broker fees 446 Additional information about fees paid to insurance 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	000010020142
Policy instance	5
Insurance contract or identification number 000010020142 Number of Individuals Covered 219 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $1,770 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,361 Commission paid to Insurance Broker USD $1,770 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010214110
Policy instance	6
Insurance contract or identification number 000010214110 Number of Individuals Covered 43 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $1,892 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $12,501 Commission paid to Insurance Broker USD $1,892 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	7
Insurance contract or identification number 000010022374 Number of Individuals Covered 218 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $4,406 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $42,778 Commission paid to Insurance Broker USD $4,406 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	8
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 48 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $2,000 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $14,355 Commission paid to Insurance Broker USD $2,000 Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3340983
Policy instance	2
Insurance contract or identification number 3340983 Number of Individuals Covered 143 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $33,444 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,279,315 Commission paid to Insurance Broker USD $33,444 Insurance broker organization code? 3
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	06073801
Policy instance	1
Insurance contract or identification number 06073801 Number of Individuals Covered 169 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $1,609 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $16,090 Commission paid to Insurance Broker USD $1,609 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	7
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 36 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $2,694 Total amount of fees paid to insurance company USD $359 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $18,640 Commission paid to Insurance Broker USD $2,694 Amount paid for insurance broker fees 359 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	06073801
Policy instance	1
Insurance contract or identification number 06073801 Number of Individuals Covered 183 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $1,615 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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 $16,157 Commission paid to Insurance Broker USD $1,615 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3340983
Policy instance	2
Insurance contract or identification number 3340983 Number of Individuals Covered 144 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $30,840 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,232,145 Commission paid to Insurance Broker USD $30,840 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	3
Insurance contract or identification number 000010020142 Number of Individuals Covered 222 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $1,597 Total amount of fees paid to insurance company USD $253 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $13,087 Commission paid to Insurance Broker USD $1,597 Amount paid for insurance broker fees 253 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00001D034655
Policy instance	4
Insurance contract or identification number 00001D034655 Number of Individuals Covered 139 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $2,256 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $43,312 Commission paid to Insurance Broker USD $2,256 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010214110
Policy instance	5
Insurance contract or identification number 000010214110 Number of Individuals Covered 43 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $2,033 Total amount of fees paid to insurance company USD $271 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $13,134 Commission paid to Insurance Broker USD $2,033 Amount paid for insurance broker fees 271 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	6
Insurance contract or identification number 000010022374 Number of Individuals Covered 222 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $4,715 Total amount of fees paid to insurance company USD $851 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $41,187 Commission paid to Insurance Broker USD $4,715 Amount paid for insurance broker fees 851 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	06073801
Policy instance	1
Insurance contract or identification number 06073801 Number of Individuals Covered 170 Insurance policy start date 2015-07-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $1,852 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit 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 $18,522 Commission paid to Insurance Broker USD $1,852 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	3
Insurance contract or identification number 000010020142 Number of Individuals Covered 255 Insurance policy start date 2015-07-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $1,853 Total amount of fees paid to insurance company USD $277 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $15,221 Commission paid to Insurance Broker USD $1,853 Amount paid for insurance broker fees 277 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010214110
Policy instance	4
Insurance contract or identification number 000010214110 Number of Individuals Covered 54 Insurance policy start date 2016-02-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $730 Total amount of fees paid to insurance company USD $97 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $4,413 Commission paid to Insurance Broker USD $730 Amount paid for insurance broker fees 97 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	5
Insurance contract or identification number 000010022374 Number of Individuals Covered 255 Insurance policy start date 2015-07-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $4,951 Total amount of fees paid to insurance company USD $922 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $49,621 Commission paid to Insurance Broker USD $4,951 Amount paid for insurance broker fees 922 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG02000
Policy instance	6
Insurance contract or identification number 00040GG02000 Number of Individuals Covered 60 Insurance policy start date 2015-07-01 Insurance policy end date 2016-01-31 Total amount of commissions paid to insurance broker USD $1,148 Total amount of fees paid to insurance company USD $141 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $7,611 Commission paid to Insurance Broker USD $1,148 Amount paid for insurance broker fees 141 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	7
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 71 Insurance policy start date 2015-07-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $3,420 Total amount of fees paid to insurance company USD $427 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE/AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $22,677 Commission paid to Insurance Broker USD $3,420 Amount paid for insurance broker fees 427 Additional information about fees paid to insurance broker OVERRIDES Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	OLVD
Policy instance	2
Insurance contract or identification number OLVD Number of Individuals Covered 180 Insurance policy start date 2015-07-01 Insurance policy end date 2016-06-30 Total amount of commissions paid to insurance broker USD $50,286 Total amount of fees paid to insurance company USD $14,711 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,583,557 Commission paid to Insurance Broker USD $50,286 Amount paid for insurance broker fees 14711 Additional information about fees paid to insurance broker MEDICAL CONTRACTS PCPM NON-MONETARY INCENTIVE AMOUNT Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	OLVD
Policy instance	1
Insurance contract or identification number OLVD Number of Individuals Covered 181 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $41,632 Total amount of fees paid to insurance company USD $19,332 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,449,460 Commission paid to Insurance Broker USD $41,632 Amount paid for insurance broker fees 19332 Additional information about fees paid to insurance broker MEDICAL CONTRACTS PCPM DENTAL CONTRACTS PCPM NON-MONETARY INCENTIVE AMOUNT Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG02000
Policy instance	3
Insurance contract or identification number 00040GG02000 Number of Individuals Covered 30 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $1,258 Total amount of fees paid to insurance company USD $13 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $6,812 Commission paid to Insurance Broker USD $1,174 Amount paid for insurance broker fees 13 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	2
Insurance contract or identification number 000010022374 Number of Individuals Covered 250 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $5,843 Total amount of fees paid to insurance company USD $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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $67,029 Commission paid to Insurance Broker USD $5,780 Amount paid for insurance broker fees 163 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	4
Insurance contract or identification number 000010020142 Number of Individuals Covered 251 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $2,131 Total amount of fees paid to insurance company USD $39 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,105 Commission paid to Insurance Broker USD $2,031 Amount paid for insurance broker fees 39 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	5
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 40 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $2,748 Total amount of fees paid to insurance company USD $37 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,508 Commission paid to Insurance Broker USD $2,537 Amount paid for insurance broker fees 37 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	AAAC
Policy instance	6
Insurance contract or identification number AAAC Number of Individuals Covered 192 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $2,137 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit 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 $21,370 Commission paid to Insurance Broker USD $2,137 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE DENTAL NETWORK (National Association of Insurance Commissioners NAIC id number: 13130 )
Policy contract number	01041
Policy instance	7
Insurance contract or identification number 01041 Number of Individuals Covered 41 Insurance policy start date 2014-07-01 Insurance policy end date 2015-06-30 Total amount of commissions paid to insurance broker USD $1,184 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $11,849 Commission paid to Insurance Broker USD $1,184 Insurance broker organization code? 3 Insurance broker name KELLY & ASSOCIATES INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG01000
Policy instance	5
Insurance contract or identification number 00040GG01000 Number of Individuals Covered 53 Insurance policy start date 2013-07-01 Insurance policy end date 2014-06-30 Total amount of commissions paid to insurance broker USD $2,080 Total amount of fees paid to insurance company USD $468 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY LIFE PRODUCTS 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 $13,874 Commission paid to Insurance Broker USD $1,684 Amount paid for insurance broker fees 468 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	AAAC
Policy instance	6
Insurance contract or identification number AAAC Number of Individuals Covered 154 Insurance policy start date 2013-07-01 Insurance policy end date 2014-06-30 Total amount of commissions paid to insurance broker USD $1,974 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit 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 $19,747 Commission paid to Insurance Broker USD $1,974 Insurance broker organization code? 3 Insurance broker name BENEFIT DESIGN GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	2
Insurance contract or identification number 000010022374 Number of Individuals Covered 274 Insurance policy start date 2013-07-01 Insurance policy end date 2013-06-30 Total amount of commissions paid to insurance broker USD $5,310 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes 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 $68,632 Commission paid to Insurance Broker USD $5,178 Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00040GG02000
Policy instance	3
Insurance contract or identification number 00040GG02000 Number of Individuals Covered 24 Insurance policy start date 2013-07-01 Insurance policy end date 2014-06-30 Total amount of commissions paid to insurance broker USD $957 Total amount of fees paid to insurance company USD $173 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes 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 $6,383 Commission paid to Insurance Broker USD $808 Amount paid for insurance broker fees 173 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	OLVD
Policy instance	1
Insurance contract or identification number OLVD Number of Individuals Covered 189 Insurance policy start date 2013-07-01 Insurance policy end date 2014-06-30 Total amount of commissions paid to insurance broker USD $55,401 Total amount of fees paid to insurance company USD $17,563 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,554,148 Commission paid to Insurance Broker USD $55,401 Amount paid for insurance broker fees 17563 Additional information about fees paid to insurance broker MEDICAL CONTRACTS PCPM NON-MONETARY INCENTIVE AMOUNT Insurance broker organization code? 3 Insurance broker name RICHARD J PRINCINSKY & ASSOCIATES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	4
Insurance contract or identification number 000010020142 Number of Individuals Covered 274 Insurance policy start date 2013-07-01 Insurance policy end date 2014-06-30 Total amount of commissions paid to insurance broker USD $1,942 Total amount of fees paid to insurance company USD $528 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,486 Commission paid to Insurance Broker USD $1,705 Amount paid for insurance broker fees 528 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name USI INSURANCE SERVICES LLC
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	AAAC
Policy instance	4
Insurance contract or identification number AAAC Number of Individuals Covered 154 Insurance policy start date 2012-07-01 Insurance policy end date 2013-06-30 Total amount of commissions paid to insurance broker USD $1,000 Total amount of fees paid to insurance company USD $1,000 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,991 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,000 Amount paid for insurance broker fees 1000 Additional information about fees paid to insurance broker ADMINISTRATORS FEE Insurance broker organization code? 5 Insurance broker name BENEFIT DESIGN GROUP, LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	3
Insurance contract or identification number 000010020142 Number of Individuals Covered 274 Insurance policy start date 2012-07-01 Insurance policy end date 2013-06-30 Total amount of commissions paid to insurance broker USD $2,162 Total amount of fees paid to insurance company USD $441 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $19,055 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,162 Amount paid for insurance broker fees 441 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name RICHARD J PRINCINSKY & ASSOC., INC.
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	0LVD
Policy instance	1
Insurance contract or identification number 0LVD Number of Individuals Covered 195 Insurance policy start date 2012-07-01 Insurance policy end date 2013-06-30 Total amount of commissions paid to insurance broker USD $57,009 Total amount of fees paid to insurance company USD $20,165 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,599,594 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $57,009 Amount paid for insurance broker fees 20165 Additional information about fees paid to insurance broker MEDICAL CONTRACTS X PCPM; DENTAL CONTRACTS X PCPM; NON-MONETARY INCENTIVE Insurance broker organization code? 3 Insurance broker name RICHARD J PRINCINSKY & ASSOC., INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	2
Insurance contract or identification number 000010022374 Number of Individuals Covered 274 Insurance policy start date 2012-07-01 Insurance policy end date 2013-06-30 Total amount of commissions paid to insurance broker USD $5,588 Total amount of fees paid to insurance company USD $1,490 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $74,611 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,588 Amount paid for insurance broker fees 1490 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3 Insurance broker name RICHARD J PRINCINSKY & ASSOC., INC.
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	AAAC
Policy instance	4
Insurance contract or identification number AAAC Number of Individuals Covered 154 Insurance policy start date 2011-07-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $1,252 Total amount of fees paid to insurance company USD $536 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $17,982 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	0LVD
Policy instance	1
Insurance contract or identification number 0LVD Number of Individuals Covered 184 Insurance policy start date 2011-07-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $44,362 Total amount of fees paid to insurance company USD $16,214 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,267,487 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	2
Insurance contract or identification number 000010022374 Number of Individuals Covered 260 Insurance policy start date 2011-07-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $4,839 Total amount of fees paid to insurance company USD $782 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $45,391 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	3
Insurance contract or identification number 000010020142 Number of Individuals Covered 259 Insurance policy start date 2011-07-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $1,639 Total amount of fees paid to insurance company USD $249 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $12,956 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number	0LVD
Policy instance	1
Insurance contract or identification number 0LVD Number of Individuals Covered 150 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $58,971 Total amount of fees paid to insurance company USD $11,215 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,179,424 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010020142
Policy instance	3
Insurance contract or identification number 000010020142 Number of Individuals Covered 205 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $1,555 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $12,023 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010022374
Policy instance	4
Insurance contract or identification number 000010022374 Number of Individuals Covered 205 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $4,435 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $38,268 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	AAAC
Policy instance	2
Insurance contract or identification number AAAC Number of Individuals Covered 120 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $1,057 Total amount of fees paid to insurance company USD $411 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,643 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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• THE ARCHWAY PROGRAMS RETIREMENT SAVINGS PLAN [EIN = 222401037]
• THE ARC OF OPPORTUNITY IN NORTH CENTRAL MASSACHUSETTS, INC. HEALTH & WELFARE PLAN [EIN = 042226199]
• THE ARC MERCER INC. RETIREMENT PLAN [EIN = 223059434]
• THE ARC, WARREN COUNTY CHAPTER GROUP VISION PLAN [EIN = 226018015]
• THE ARCHWAY PROGRAMS WELFARE BENEFIT PLAN [EIN = 521782940]
• THE ARC OF SHELBY COUNTY 403(B) PLAN [EIN = 630988453]
• THE ARC OF ANCHORAGE HEALTH AND WELFARE PLAN [EIN = 920028571]
• THE ARC OF BERGEN AND PASSAIC COUNTIES MEDICAL PLAN [EIN = 221620254]
• THE ARC OF SAN DIEGO HEALTH & WELFARE PLAN [EIN = 951863913]
• THE ARC PRINCE GEORGE'S COUNTY INSURED WELFARE PLAN - LIFE [EIN = 520715246]
• THE ARC GREATER TWIN CITIES EMPLOYEE BENEFIT PLAN [EIN = 410782848]
• THE ARC OF MONTGOMERY COUNTY VOLUNTARY SHORT TERM DISABILITY [EIN = 520639953]
• THE ARC OF SOMERSET COUNTY, INC. HEALTH & WELFARE PLAN [EIN = 221968555]
• THE ARCLIGHT CAPITAL HOLDINGS RETIREMENT SAVINGS PLAN [EIN = 043548448]
• THE ARC OF CAPE MAY COUNTY, INC. 403(B) PLAN [EIN = 222271013]
• THE ARC OF NORTHEASTERN PENNSYLVANIA GROUP HEALTH BENEFIT PLAN [EIN = 240838702]
• THE ARC, WARREN COUNTY CHAPTER LONG TERM DISABILITY PLAN [EIN = 226018015]
• THE ARCHITECTURAL TEAM, INC. NEW COMPARABILITY 401(K) PROFIT SHARING PLAN [EIN = 042895637]
• THE ARC OF OPPORTUNITY IN NORTH CENTRAL MASSACHUSETTS 401K PROFIT SHARING PLAN AND TRUST [EIN = 042226199]
• THE ARC GLOUCESTER WELFARE BENEFITS PLAN [EIN = 210697151]
• THE ARC MADISON CORTLAND NYSARC, INC. [EIN = 160958020]
• THE ARC OF UNION COUNTY, INC. RETIREMENT PLAN [EIN = 221686764]
• THE ARC - WARREN COUNTY CHAPTER, INC. 403(B) PLAN [EIN = 226018015]
• THE ARC OF ALACHUA COUNTY, INC. DISCRETIONARY CONTRIBUTION AND SAVINGS PLAN [EIN = 591140179]
• THE ARC OF RENSSELAER COUNTY WELFARE BENEFITS PLAN [EIN = 141485873]
• THE ARC OF DELAWARE COUNTY HEALTH & WELFARE BENEFITS PLAN [EIN = 160976343]
• THE ARC WARREN COUNTY CHAPTER GROUP DENTAL PLAN [EIN = 226018015]
• THE ARC OF FREDERICK COUNTY TAX DEFERRED SAVINGS PLAN [EIN = 526055211]
• THE ARC TAMPA BAY HEALTH AND WELFARE PLAN [EIN = 591056551]
• THE ARCHITECTS ENTERPRISE LTD. EMPLOYEES PROFIT SHARING PLAN [EIN = 363625735]
• THE ARC WARREN COUNTY CHAPTER HEALTH BENEFITS PLAN [EIN = 226018015]
• THE ARC MONTGOMERY COUNTY TAX SHELTERED ANNUITY PLAN [EIN = 520639953]
• THE ARC JACKSONVILLE 403(B) PLAN [EIN = 596209603]
• THE ARC OF MONROE CO., NYSARC, INC. HEALTH & WELFARE BENEFITS PLAN [EIN = 160835172]
• THE ARC PRINCE GEORGE'S COUNTY MEDICAL PLAN [EIN = 520715246]
• THE ARC, OCEAN COUNTY CHAPTER, INC. RETIREMENT SAVINGS PLAN [EIN = 210723435]
• THE ARC, OCEAN COUNTY CHAPTER DENTAL PLAN [EIN = 210723435]
• THE ARC OF SOUTHWEST GEORGIA 401(K) PROFIT SHARING PLAN [EIN = 581234047]
• THE ARC OF HOWARD COUNTY, INC. MATCHED SAVINGS PLAN [EIN = 520884366]
• THE ARC PRINCE GEORGE'S COUNTY DENTAL PLAN [EIN = 520715246]
• THE ARC OF MONTGOMERY COUNTY DENTAL PLAN [EIN = 520639953]
• THE ARCHITECT 401(K) PLAN - NISHNA PRODUCTIONS, INC. [EIN = 421025042]
• THE ARC OF SOUTHERN MARYLAND FLEXIBLE BENEFITS PLAN [EIN = 521062351]
• THE ARC OF WASHINGTON COUNTY, INC. HEALTH AND WELFARE PLAN [EIN = 520696197]
• THE ARC OF MONROE CO. , NYSARC, INC. FLEX OPTIONS PLAN [EIN = 160835172]
• THE ARC WARREN COUNTY CHAPTER GROUP LIFE AND ADD PLAN [EIN = 226018015]
• THE ARC OF MONROE COUNTY DEFINED CONTRIBUTION RETIREMENT PLAN [EIN = 160835172]
• THE ARC OF STEUBEN 401(K) PLAN [EIN = 160971450]
• THE ARC OF MONMOUTH, INC., WELFARE PLAN [EIN = 210657022]
• THE ARC ALLEGANY-STEUBEN MONEY PURCHASE PLAN [EIN = 161021588]
• THE ARC OF ORANGE COUNTY HEALTH & WELFARE BENEFITS PLAN [EIN = 141462340]
• THE ARC OF ORLEANS COUNTY RETIREMENT PLAN [EIN = 237150957]
• THE ARC OF THE ST. JOHNS 403(B) PLAN [EIN = 237201838]
• THE ARC OF NORTH CAROLINA, INC. 401(K) PLAN [EIN = 560753097]
• THE ARC OF BLACKSTONE VALLEY MEDICAL AND DENTAL INSURANCE PLAN [EIN = 050300152]
• THE ARCHITECT 401(K) PLAN THE PRINTER, INC. [EIN = 421007951]
• THE ARCHITECT 401(K) MEP [EIN = 900851287]
• THE ARC BALTIMORE EMPLOYEE BENEFITS PLAN [EIN = 520671428]
• THE ARC OF THE QUAD CITIES AREA MONEY PURCHASE PLAN [EIN = 362615996]
• THE ARCHER SCHOOL FOR GIRLS DC RETIREMENT PLAN [EIN = 954463705]
• THE ARC OF MADISON COUNTY, INC 401(K) PROFIT SHARING PLAN [EIN = 630418986]
• THE ARC OF MONMOUTH, INC. 403(B) PLAN [EIN = 210657022]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC SECTION 105 PLAN [EIN = 150581298]
• THE ARCHITECTURAL STUDIO 401(K) PROFIT SHARING PLAN [EIN = 232994822]
• THE ARC SOUTHEASTERN MINNESOTA [EIN = 416042617]
• THE ARC OF ULSTER-GREENE NYSARC, INC. HEALTH & WELFARE BENEFITS PLAN [EIN = 141437657]
• THE ARC FRESNO/MADERA COUNTIES RETIREMENT PLAN [EIN = 941265038]
• THE ARC OF BERGEN AND PASSAIC COUNTIES INC. 401(K) RETIREMENT PLAN [EIN = 221620254]
• THE ARC OF SAN DIEGO HEALTH AND WELFARE PLAN [EIN = 951863913]
• THE ARC OF VENTURA COUNTY WELFARE BENEFIT PLAN [EIN = 952266987]
• THE ARC WARREN COUNTY CHAPTER PRESCRIPTION PLAN [EIN = 226018015]
• THE ARC OF ANCHORAGE 401(K) PLAN [EIN = 920028571]
• THE ARC IN HAWAII FLEXIBLE BENEFITS PLAN [EIN = 990089327]
• THE ARC OF DELAWARE COUNTY SECTION 105(H) HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 160976343]
• THE ARC OF BERGEN AND PASSAIC COUNTIES LIFE AND DISABILITY PLAN [EIN = 221620254]
• THE ARC MONTGOMERY COUNTY PENSION PLAN [EIN = 520639953]
• THE ARC OF UNION COUNTY, INC. BENEFIT PLAN [EIN = 221686764]
• THE ARC OF ALACHUA COUNTY INC HEALTH AND WELFARE PLAN [EIN = 591140179]
• THE ARC MADISON CORTLAND NYSARC, INC. WELFARE BENEFITS PLAN [EIN = 160958020]
• THE ARC OF PRINCE GEORGES COUNTY RETIREMENT & EMPLOYEE SAVINGS PLAN [EIN = 520715246]
• THE ARC OF DELAWARE COUNTY SECTION 125 CAFETERIA PLAN [EIN = 160976343]
• THE ARC SAN FRANCISCO HEALTH & WELFARE PLAN [EIN = 941415287]
• THE ARC OF MONTGOMERY COUNTY WELFARE BENEFIT PLAN [EIN = 520639953]
• THE ARC OF BLACKSTONE VALLEY GROUP TERM LIFE/ADD INSURANCE [EIN = 050300152]
• THE ARC OF CENTRE COUNTY PA, INC. 401K PROFIT SHARING PLAN [EIN = 240859375]
• THE ARC OF PUTNAM COUNTY, INC. 403(B) PLAN [EIN = 591550224]
• THE ARCHITECTURAL GROUP, INC. PROFIT SHARING PLAN [EIN = 311302775]
• THE ARCO INC. PROFIT SHARING PLAN [EIN = 223279336]
• THE ARCHITECT 401(K) PLAN - MIDWEST PROJECT PARTNERS, INC. [EIN = 421523898]
• THE ARCHITECT 401(K) PLAN - GEETINGS, INC. [EIN = 420988392]
• THE ARCHITECT 401(K) PLAN - SUPERIOR SIDING, INC. [EIN = 421397989]
• THE ARCHITECTS PARTNERSHIP, LTD. EMPLOYEES PROFIT SHARING PLAN & TRUST [EIN = 912035533]
• THE ARCHITECT 401(K) MEP [EIN = 262628420]
• THE ARCHITECT 401(K) PLAN - JOHN H GARTON DDS [EIN = 800905480]
• THE ARC OF MICHIGAN 403(B) TAX DEFERRED ANNUITY PLAN [EIN = 381536920]
• THE ARCHITECTS HOUSING COMPANY 401 K PROFIT SHARING PLAN TRUST [EIN = 222169930]
• THE ARCHITECT 401(K) PLAN - BRUIN MANUFACTURING COMPANY, INC [EIN = 420755515]
• THE ARC OF TUSCALOOSA 403(B) PLAN [EIN = 630423005]
• THE ARCHITECT 401(K) PLAN - ASSURE HEALTH LINK, LLC DBA CAPTURE MARKETING [EIN = 270398813]
• THE ARC OF DAVIDSON COUNTY 403(B) PLAN [EIN = 620588710]
• THE ARC OF THE OZARKS [EIN = 436049004]
• THE ARCHITECT 401(K) PLAN- K. RENEE HOME, LLC [EIN = 454940343]
• THE ARCHITECT 401(K)PLAN - ICS ADVANCED TECHNOLOGIES [EIN = 470852889]
• THE ARCHITECT 401(K) PLAN - EVORA GROUP, LTD. [EIN = 421441833]
• THE ARCHITECTURAL GROUP, INC. 401K AND PROFIT SHARING PLAN [EIN = 382220794]
• THE ARC OF KING COUNTY 401(K) PLAN [EIN = 910594684]
• THE ARC OF SPOKANE RETIREMENT PLAN [EIN = 910716160]
• THE ARC OF LOUDOUN 401(K) PLAN [EIN = 540835314]
• THE ARCHITECT 401(K)PLAN - RECKER DENTAL CARE, PC [EIN = 264113404]
• THE ARCHITECT 401(K) PLAN - MEDIVAC AMBULANCE, CORP. [EIN = 421125457]
• THE ARCHITECT 401(K)PLAN - INDUSTRY MARKETING SOLUTIONS LLC [EIN = 571139533]
• THE ARCHITECT 401(K) PLAN - EYECARE PARTNERS, P.C. [EIN = 421151744]
• THE ARCHITECT 401(K) PLAN - FORT DODGE FORD, LINCOLN, TOYOTA, INC. [EIN = 421460937]
• THE ARCHITECT 401(K) PLAN - GREATER FORT DODGE GROWTH ALLIANCE [EIN = 273646585]
• THE ARCHAEOLOGICAL CONSERVANCY 403(B) PLAN [EIN = 953403273]
• THE ARCHITECT 401(K) PLAN - NELSON DAIRY CONSULTANTS, INC. [EIN = 421053300]
• THE ARCHITECTURAL STUDIO, INC. 401K PLAN [EIN = 721125788]
• THE ARC OF INDIANA 403(B) PLAN [EIN = 351075886]
• THE ARC OF CADDO-BOSSIER, INC. DBA FROST INDUSTRIES HEALTH & WELFARE PLAN [EIN = 720482891]
• THE ARCHITECT 401(K) PLAN - MCGREGOR COMPANY [EIN = 420405550]
• THE ARCHITECT 401(K) PLAN- ADVANCED AUTOMATION, INC. [EIN = 421411991]
• THE ARCHITECT 401(K) PLAN- NEWKENY PHARMACY, LLC [EIN = 421490774]
• THE ARCHITECT 401(K)PLAN - WCF FINANCIAL BANK [EIN = 421491186]
• THE ARCHITECT 401(K) PLAN - IOWA FAIR PLAN ASSOCIATION [EIN = 420941910]
• THE ARCHITECT 401(K) PLAN - LEXINGTON SQUARE 401(K) PLAN [EIN = 200473448]
• THE ARCHITECT 401(K)PLAN - THE MILLS AGENCY, INC [EIN = 421055904]
• THE ARCHITECT 401(K) PLAN - MEDIVAC AMBULANCE, CORP. [EIN = 421125457]
• THE ARCHITECT 401(K) PLAN - GLEN OAKS COUNTRY CLUB [EIN = 272779479]
• THE ARCHITECT 401(K) PLAN- FLOURISH HOSPITALITY [EIN = 452874396]
• THE ARCHITECT 401(K) PLAN- DUBUQUE SCREW PRODUCTS, INC. [EIN = 420629107]
• THE ARCHITECT 401(K) PLAN - RAM HOLDINGS, INC. [EIN = 460794578]
• THE ARCHITECT 401(K) PLAN- COMPASS CLINICAL ASSOCIATES, PLLC [EIN = 455541865]
• THE ARCHITECT 401(K) MEP [EIN = 990371099]
• THE ARCHIVES LLC 401(K) PLAN [EIN = 204660613]
• THE ARCA FOUNDATION PROFIT SHARING PLAN [EIN = 132751798]
• THE ARC OF FOND DU LAC 401(K) PLAN [EIN = 391034161]
• THE ARCHAEOLOGICAL CONSERVANCY RETIREMENT PLAN [EIN = 953403273]
• THE ARC OF WASHINGTON COUNTY 401(K) [EIN = 620694557]
• THE ARC OF OAKLAND COUNTY 403(B) PLAN [EIN = 381869548]
• THE ARCHITECT 401(K) PLAN- PERENNIAL PROPERTIES MANAGEMENT SERVICES [EIN = 710951624]
• THE ARC OF PUEBLO, INC. 401K PLAN [EIN = 846037693]
• THE ARCHITECT 401(K) PLAN- JUSTIN J. RAATZ, DPM, PLLC [EIN = 813158813]
• THE ARCHITECT 401(K) PLAN- IMEXCO, INC. [EIN = 421415702]
• THE ARC OF SOMERSET COUNTY PENSION PLAN [EIN = 221968555]
• THE ARC OF MOORE COUNTY INC. RETIREMENT PLAN [EIN = 560960343]
• THE ARC NATURE COAST TAX DEFERRED ANNUITY PLAN [EIN = 237305830]
• THE ARC MESA COUNTY, INC. 401(K) PLAN [EIN = 846038382]
• THE ARCHITECT 401(K) PLAN- CALUMET CARRIERS, INC., [EIN = 421384468]
• THE ARCHITECT 401(K) PLAN- INFO NET, CORP DBA SUMMIT PRODUCTS, INC. [EIN = 421453534]
• THE ARCA FOUNDATION 403(B) PLAN [EIN = 132751798]
• THE ARCHITECT 401(K)PLAN - TC2, INC [EIN = 463119588]
• THE ARCHITECT 401(K)PLAN - WCF FINANCIAL BANK [EIN = 812510023]
• THE ARC OF GREATER HAVERHILL - NEWBURYPORT 403(B) PLAN [EIN = 046154794]
• THE ARCHITECT 401(K) PLAN - THE FINWAY GROUP [EIN = 421468222]
• THE ARCHITECT 401(K) PLAN - MID AMERICA TRENCHERS [EIN = 421646568]
• THE ARC OF WASHINGTON STATE BENEFIT PLAN [EIN = 910747027]
• THE ARCHITECT 401(K) PLAN- SUPERIOR CARPET & UPHOLSTERY CARE [EIN = 202898090]
• THE ARC OF EAST CENTRAL IOWA 401(K) PLAN [EIN = 420805377]
• THE ARCHITECT 401(K) PLAN - DAVIS PIPE & SUPPLY, INC [EIN = 731222547]
• THE ARCHITECT 401(K) MEP [EIN = 421030179]
• THE ARCHITECT 401(K) PLAN - EWING LAND DEVELOPMENT & SERVICES, LLC [EIN = 542098780]
• THE ARCHITECT 401(K) PLAN- PROPLANNER, INC. [EIN = 753028362]
• THE ARCHITECT 401(K) PLAN - FARM SAFETY FOR JUST KIDS [EIN = 421309917]
• THE ARC OF NEW JERSEY PROFIT SHARING TRUST [EIN = 221665355]
• THE ARC OF THE UNITED STATES DEFINED CONTRIBUTION [EIN = 135642032]
• THE ARCHITECTURE COMPANY 401(K) PLAN [EIN = 860547413]
• THE ARC OF DURHAM COUNTY 403 (B) RETIREMENT PLAN [EIN = 560689237]
• THE ARC OF NORTHEASTERN PENNSYLVANIA RETIREMENT PLAN [EIN = 240838702]
• THE ARCANUM GROUP 401K PROFIT SHARING PLAN AND TRUST [EIN = 232924653]
• THE ARC NATURE COAST 401-K PLAN [EIN = 237305830]
• THE ARC, ONEIDA-LEWIS CHAPTER NYSARC PROFIT SHARING PLAN [EIN = 150581298]
• THE ARC OF ALAMEDA COUNTY 401(K) PS RETIREMENT PLAN TRUST [EIN = 941707724]
• THE ARC OF BALTIMORE, INC. HEALTH PLAN [EIN = 520671428]
• THE ARC ONEIDA-LEWIS - MEDICAL PLAN [EIN = 150581298]
• THE ARC OF CAMDEN COUNTY 403(B) PLAN [EIN = 222192479]
• THE ARC ONEIDA-LEWIS- VISION PLAN [EIN = 150581298]
• THE ARCHITECT 401(K) PLAN- ORCHESTRATE HOSPITALITY GROUP [EIN = 208519624]
• THE ARC OF FAYETTE COUNTY 403(B) PLAN [EIN = 251121875]
• THE ARC JACKSONVILLE, WELFARE BENEFIT PLAN [EIN = 596209603]
• THE ARC OF NEW LONDON COUNTY [EIN = 066010477]
• THE ARCHITECT 401(K) PLAN KNIGHT ENTERPRISES [EIN = 593100430]
• THE ARC OF MONROE CO. , NYSARC, INC. MEDICAL REIMBURSEMENT PLAN [EIN = 160835172]
• THE ARC OF SAN DIEGO 401(K) SAVINGS PLAN [EIN = 951863913]
• THE ARC OF CARROLL COUNTY [EIN = 520707322]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC WELFARE BENEFIT PLAN [EIN = 150581298]
• THE ARC OF SOUTHERN MARYLAND RETIREMENT SAVINGS PLAN [EIN = 521062351]
• THE ARC NORTHERN CHESAPEAKE REGION, INC. PREMIUM CONVERSION PLAN [EIN = 520784063]
• THE ARC OF THE FARMINGTON VALLEY INC WRAP DOCUMENT [EIN = 066011136]
• THE ARC OF RIVERSIDE COUNTY HEALTH AND WELFARE PLAN [EIN = 951907771]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC SECTION 125 [EIN = 150581298]
• THE ARC OF SPOKANE WELFARE PLAN [EIN = 910716160]
• THE ARC OF MASSACHUSETTS [EIN = 042223502]
• THE ARCHITECT 401(K) PLAN- GULL WING INDUSTRIES, INC. [EIN = 421351640]
• THE ARCHITECT 401(K) PLAN- QTC / QSI [EIN = 810558645]
• THE ARCHITECT 401(K) PLAN- H & F MANUFACTURING COMPANY, INC. [EIN = 810394471]
• THE ARC OF GENESEE ORLEANS SECTION 105(H) HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 237150957]
• THE ARCHITECT 401(K) PLAN- KINGLAND CONSTRUCTION SERVICES [EIN = 462272230]
• THE ARCHITECT 401(K) PLAN- AVIATION MANAGEMENT [EIN = 454318949]
• THE ARCHITECT 401(K) PLAN- IOWA BREWING CO. [EIN = 463125267]
• THE ARC OF STEUBEN SECTION 105(H) HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 160971450]
• THE ARCHITECT 401(K) PLAN - HOLT PLUMBING & HEATING, INC. [EIN = 421147531]
• THE ARCHITECT 401(K) PLAN- VMC MANAGEMENT [EIN = 421475635]
• THE ARC OF GENESEE ORLEANS WELFARE BENEFITS PLAN [EIN = 237150957]
• THE ARCHITECT 401(K) PLAN- ALB RESTAURANTS 401(K) PLAN [EIN = 263784336]
• THE ARCHITECT 401(K) PLAN- GLACIAL LAKES RUBBER & PLASTICS, LLC [EIN = 464717858]
• THE ARCHER SCHOOL FOR GIRLS WELFARE PLAN [EIN = 954463705]
• THE ARC NATURE COAST 401-K PLAN [EIN = 238305830]
• THE ARCHER SCHOOL FOR GIRLS 125 CAFETERIA PLAN [EIN = 954463705]
• THE ARC OF SAN DIEGO MEDICAL PLAN [EIN = 951863913]
• THE ARC PRINCE GEORGE'S COUNTY VISION PLAN [EIN = 520715246]
• THE ARC OCEAN COUNTY CHAPTER INC. HEALTH & WELFARE PLAN [EIN = 210723435]
• THE ARC/MORRIS COUNTY CHAPTER, NJ, INC. FLEXIBLE BENEFITS PLAN [EIN = 221629144]
• THE ARC TAMPA BAY, INC. RETIREMENT PLAN [EIN = 591056551]
• THE ARC OF NORTHEASTERN PENNSYLVANIA LIFE AND DISABILITY PLAN [EIN = 240838702]
• THE ARC OF MONTGOMERY COUNTY HEALTH PLAN [EIN = 520639953]
• THE ARC OF MONTGOMERY COUNTY VOLUNTARY LIFE AND AD&D PLAN [EIN = 520639953]
• THE ARC KENT COUNTY, INC. TSA RETIREMENT PLAN [EIN = 381360508]
• THE ARC 401(K) PROFIT SHARING PLAN [EIN = 931179075]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC DENTAL PLAN [EIN = 150581298]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC GROUP LIFE, VOL LIFE, AND AD&D PLAN [EIN = 150581298]
• THE ARC, ONEIDA-LEWIS CHAPTER, NYSARC LONG TERM DISABILITY PLAN [EIN = 150581298]
• THE ARCHWAYS 401(K) PLAN [EIN = 610878922]
• THE ARC OF OPPORTUNITY IN NORTH CENTRAL MASSACHUSETTS 401K PROFIT SHARING PLAN AND TRUST [EIN = 043506872]
• THE ARC NORTHWEST INDIANA PROFIT SHARING PLAN [EIN = 351055076]
• THE ARCHITECT 401(K) PLAN- KYLE OLSON DDS, PC [EIN = 815346753]
• THE ARCHITECT 401(K) PLAN- WOOLSTOCK MUTUAL TELEPHONE ASSOCIATION [EIN = 420701913]
• THE ARCHITECT 401(K) PLAN- TRACO, LLC [EIN = 275198340]
• THE ARC OF SOMERSET COUNTY, INC. VISION PLAN [EIN = 221968555]
• THE ARCHITECTURE COMPANY 401(K) PLAN [EIN = 860547413]
• THE ARCOT SYSTEMS, INC. 401(K) PLAN [EIN = 770467362]
• THE ARC OF PRINCE GEORGES COUNTY INSURED WELFARE PLAN - LIFE [EIN = 520175246]
• THE ARCHITECT 401(K) PLAN- TIPT, PLLC [EIN = 814030524]
• THE ARCHITECT 401(K) PLAN- DARWIN T. LYNNER CO., INC. [EIN = 421241366]
• THE ARCHITECT 401(K) PLAN- ALL STAR CONCRETE, LLC [EIN = 464322373]
• THE ARCHITECT 401(K) PLAN- ELITE OCTANE, LLC [EIN = 205303852]
• THE ARCHITECT 401(K) PLAN- ZUIDBERG NORTH AMERICA, INC. [EIN = 464413013]
• THE ARCHITECT 401(K) PLAN- FREMONT COUNTY VET CLINIC [EIN = 421048350]
• THE ARCHITECT 401(K) PLAN- FARMBOY, INC. [EIN = 710951677]
• THE ARC - WARREN COUNTY CHAPTER, INC. HEALTH & WELFARE BENEFITS PLAN [EIN = 226018015]
• THE ARCHITECT 401(K) PLAN- INROADS, LLC [EIN = 821949617]
• THE ARCHITECT 401(K) PLAN- IOWA HEALTH INFORMATION NETWORK [EIN = 815182414]
• THE ARCHITECT 401(K) PLAN- MC & R POOLS, INC. [EIN = 460449155]
• THE ARCHITECT 401(K) PLAN- RDG MEDIA, INC. [EIN = 823078999]
• THE ARCHITECT 401(K) PLAN- VERO CHIROPRACTIC, PLLC [EIN = 815213703]
• THE ARC OREGON CAFETERIA PLAN [EIN = 930504507]
• THE ARCHITECT 401(K) PLAN- WARM TRUCKING, INC. [EIN = 270174152]
• THE ARC ALLIANCE 401K PLAN [EIN = 311592547]
• THE ARC OF OWENSBORO INC CBS BENEFIT PLAN [EIN = 610539889]
• THE ARC MINNESOTA EMPLOYEE BENEFIT PLAN [EIN = 410795254]
• THE ARC OF CENTRE COUNTY, PA., INC. EMPLOYEE BENEFIT PLAN [EIN = 240859375]
• THE ARC OF CAPE MAY COUNTY, INC. HEALTH & WELFARE PLAN [EIN = 222271013]
• THE ARCTICOM GROUP, LLC 401(K) PLAN [EIN = 821463967]
• THE ARC OF MIDDLESEX COUNTY HEALTH AND WELFARE PLAN [EIN = 221695038]
• THE ARC NATURE COAST, INC WELFARE BENEFIT PLAN [EIN = 237305830]
• THE ARC OF LEHIGH AND NORTHAMPTON COUNTIES, INC. EMPLOYEE BENEFIT PLAN [EIN = 231679102]
• THE ARC GATEWAY, INC. 401K PLAN [EIN = 590940528]
• THE ARCHITECT'S NEWSPAPER - 401(K) [EIN = 510485153]
• THE ARC OTSEGO HEALTH & WELFARE WRAP BENEFIT PLAN [EIN = 160953477]
• THE ARC OTSEGO GROUP HEALTH PLAN [EIN = 160953477]
• THE ARC OF CENTRAL ALABAMA, INC. WELFARE BENEFITS PLAN [EIN = 630375738]
• THE ARC NEW YORK AFFILIATED EMPLOYERS 403(B) PLAN [EIN = 135678837]
• THE ARC NEW YORK AFFILIATED EMPLOYERS 401(K) PLAN [EIN = 135678837]
• THE ARC JEFFERSON-ST. LAWRENCE 403(B) PLAN FOR ST. LAWRENCE COUNTY EMPLOYEES [EIN = 161134631]
• THE ARCTICOM GROUP EMPLOYEE BENEFITS PLAN [EIN = 821463967]
• THE ARCON GROUP MS, LLC 401K PLAN [EIN = 261693405]
• THE ARCHITECT 401(K) PLAN- AVIATION MANAGEMENT II [EIN = 822643833]
• THE ARC OF CRAWFORD COUNTY PLAN DOCUMENT [EIN = 251070244]
• THE ARC OF KING COUNTY EMPLOYEE BENEFIT PLAN [EIN = 910594684]
• THE ARCADE 401(K) PLAN [EIN = 822163329]
• THE ARC ALLEGANY-STEUBEN 401(K) PLAN [EIN = 161021588]
• THE ARC OF MONMOUTH, INC. MEDICAL PLAN [EIN = 210657022]
• THE ARCHITECT RETIREMENT PEP [EIN = 421468222]
• THE ARC GATEWAY, INC. 403(B) PLAN [EIN = 590940528]
• THE ARC OF GRAYS HARBOR 403(B) RETIREMENT PLAN [EIN = 912010058]
• THE ARCHITECTURAL LEAGUE OF NEW YORK 401(K) PLAN [EIN = 131671027]
• THE ARC OF WELD COUNTY 401(K) PLAN [EIN = 841222223]
• THE ARC OF THE PENINSULAS 403(B) PLAN [EIN = 910908572]
• THE ARC OF BERGEN AND PASSAIC COUNTIES HEALTH AND WELFARE BENEFIT PLAN [EIN = 221620254]
• THE ARC OF PALM BEACH COUNTY HEALTH AND WELFARE BENEFITS WRAP PLAN [EIN = 590883386]
• THE ARC OF CUMBERLAND AND PERRY COUNTIES EMPLOYEE BENEFIT PLAN [EIN = 231489837]
• THE ARC OF CUMBERLAND AND PERRY COUNTIES GROUP MEDICAL PLAN [EIN = 231489837]
• THE ARC OF THE QUAD CITIES AREA HEALTH AND WELFARE BENEFIT PLAN [EIN = 362615996]