401k Plan data: MID EASTERN BUILDERS, INC. FRINGE BENEFITS plan

MID EASTERN BUILDERS, INC. FRINGE BENEFITS 401k Plan overview

Plan Name	MID EASTERN BUILDERS, INC. FRINGE BENEFITS
Plan identification number	501

MID EASTERN BUILDERS, INC. FRINGE BENEFITS Benefits

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

401k Sponsoring company profile

MEB GENERAL CONTRACTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name: MEB GENERAL CONTRACTORS, INC.

Employer identification number (EIN): 541194996

NAIC Classification: 237990
NAIC Description: Other Heavy and Civil Engineering Construction

Additional information about MEB GENERAL CONTRACTORS, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1982-03-25

Company Identification Number: 0228139

Legal Registered Office Address: 4016 HOLLAND BOULEVARD

CHESAPEAKE
United States of America (USA)
23323

More information about MEB GENERAL CONTRACTORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID EASTERN BUILDERS, INC. FRINGE BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-03-01
501 2021-03-01
501 2020-03-01
501 2019-03-01
501 2018-03-01
501 2017-03-01 GEORGE B. CLARKE, IV
501 2016-03-01 GEORGE B. CLARKE, IV
501 2015-03-01 GEORGE B. CLARKE, IV
501 2014-03-01 GEORGE B. CLARKE, IV
501 2013-03-01 GEORGE B. CLARKE, IV
501 2012-03-01 GEORGE B. CLARKE, IV
501 2011-03-01 GEORGE B. CLARKE, IV
501 2008-03-01

Plan Statistics for MID EASTERN BUILDERS, INC. FRINGE BENEFITS

401k plan membership statisitcs for MID EASTERN BUILDERS, INC. FRINGE BENEFITS

Measure Date Value
2022: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2022 401k membership
Total participants, beginning-of-year 2022-03-01 359
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 408
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 408
2021: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-03-01 349
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 359
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 359
2020: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2020 401k membership
Total participants, beginning-of-year 2020-03-01 350
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 349
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 349
2019: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2019 401k membership
Total participants, beginning-of-year 2019-03-01 344
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 350
Number of retired or separated participants receiving benefits 2019-03-01 0
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 350
2018: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2018 401k membership
Total participants, beginning-of-year 2018-03-01 0
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 344
Number of retired or separated participants receiving benefits 2018-03-01 0
Number of other retired or separated participants entitled to future benefits 2018-03-01 0
Total of all active and inactive participants 2018-03-01 344
2017: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-03-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 0
Number of retired or separated participants receiving benefits 2017-03-01 0
Number of other retired or separated participants entitled to future benefits 2017-03-01 0
Total of all active and inactive participants 2017-03-01 0
2016: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-03-01 546
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 0
Number of retired or separated participants receiving benefits 2016-03-01 0
Number of other retired or separated participants entitled to future benefits 2016-03-01 0
Total of all active and inactive participants 2016-03-01 0
2015: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2015 401k membership
Total participants, beginning-of-year 2015-03-01 336
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 546
Number of retired or separated participants receiving benefits 2015-03-01 0
Number of other retired or separated participants entitled to future benefits 2015-03-01 0
Total of all active and inactive participants 2015-03-01 546
2014: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2014 401k membership
Total participants, beginning-of-year 2014-03-01 375
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 336
Number of retired or separated participants receiving benefits 2014-03-01 0
Number of other retired or separated participants entitled to future benefits 2014-03-01 0
Total of all active and inactive participants 2014-03-01 336
2013: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2013 401k membership
Total participants, beginning-of-year 2013-03-01 259
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 375
Total of all active and inactive participants 2013-03-01 375
Total participants 2013-03-01 375
2012: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2012 401k membership
Total participants, beginning-of-year 2012-03-01 167
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 259
Total of all active and inactive participants 2012-03-01 259
Total participants 2012-03-01 259
2011: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2011 401k membership
Total participants, beginning-of-year 2011-03-01 366
Total number of active participants reported on line 7a of the Form 5500 2011-03-01 167
Total of all active and inactive participants 2011-03-01 167
Total participants 2011-03-01 167

Measure	Date	Value
2022: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2022 401k membership
Total participants, beginning-of-year	2022-03-01	359
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	408
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	408
2021: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-03-01	349
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	359
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	359
2020: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2020 401k membership
Total participants, beginning-of-year	2020-03-01	350
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	349
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	349
2019: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2019 401k membership
Total participants, beginning-of-year	2019-03-01	344
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	350
Number of retired or separated participants receiving benefits	2019-03-01	0
Number of other retired or separated participants entitled to future benefits	2019-03-01	0
Total of all active and inactive participants	2019-03-01	350
2018: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2018 401k membership
Total participants, beginning-of-year	2018-03-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	344
Number of retired or separated participants receiving benefits	2018-03-01	0
Number of other retired or separated participants entitled to future benefits	2018-03-01	0
Total of all active and inactive participants	2018-03-01	344
2017: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-03-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	0
Number of retired or separated participants receiving benefits	2017-03-01	0
Number of other retired or separated participants entitled to future benefits	2017-03-01	0
Total of all active and inactive participants	2017-03-01	0
2016: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-03-01	546
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	0
Number of retired or separated participants receiving benefits	2016-03-01	0
Number of other retired or separated participants entitled to future benefits	2016-03-01	0
Total of all active and inactive participants	2016-03-01	0
2015: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2015 401k membership
Total participants, beginning-of-year	2015-03-01	336
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	546
Number of retired or separated participants receiving benefits	2015-03-01	0
Number of other retired or separated participants entitled to future benefits	2015-03-01	0
Total of all active and inactive participants	2015-03-01	546
2014: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2014 401k membership
Total participants, beginning-of-year	2014-03-01	375
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	336
Number of retired or separated participants receiving benefits	2014-03-01	0
Number of other retired or separated participants entitled to future benefits	2014-03-01	0
Total of all active and inactive participants	2014-03-01	336
2013: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2013 401k membership
Total participants, beginning-of-year	2013-03-01	259
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	375
Total of all active and inactive participants	2013-03-01	375
Total participants	2013-03-01	375
2012: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2012 401k membership
Total participants, beginning-of-year	2012-03-01	167
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	259
Total of all active and inactive participants	2012-03-01	259
Total participants	2012-03-01	259
2011: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2011 401k membership
Total participants, beginning-of-year	2011-03-01	366
Total number of active participants reported on line 7a of the Form 5500	2011-03-01	167
Total of all active and inactive participants	2011-03-01	167
Total participants	2011-03-01	167

Financial Data on MID EASTERN BUILDERS, INC. FRINGE BENEFITS

Measure	Date	Value
2012 : MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2012 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-02-29	No
Was this plan covered by a fidelity bond	2012-02-29	No
Were there any nonexempt tranactions with any party-in-interest	2012-02-29	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-02-29	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-02-29	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-02-29	No
Were any leases to which the plan was party in default or uncollectible	2012-02-29	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-02-29	No
Was there a failure to transmit to the plan any participant contributions	2012-02-29	No
Has the plan failed to provide any benefit when due under the plan	2012-02-29	No
Did the plan have assets held for investment	2012-02-29	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-02-29	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-02-29	No

Form 5500 Responses for MID EASTERN BUILDERS, INC. FRINGE BENEFITS

2022: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2021: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2020: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2019: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2018: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2017: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes
2016: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2016 form 5500 responses
2016-03-01	Type of plan entity	Single employer plan
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes
2015: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2014: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes
2013: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2012: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2011: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2011 form 5500 responses
2011-03-01	Type of plan entity	Single employer plan
2011-03-01	Submission has been amended	Yes
2011-03-01	Plan funding arrangement – Insurance	Yes
2011-03-01	Plan benefit arrangement – Insurance	Yes
2008: MID EASTERN BUILDERS, INC. FRINGE BENEFITS 2008 form 5500 responses
2008-03-01	Type of plan entity	Single employer plan
2008-03-01	Submission has been amended	No
2008-03-01	This submission is the final filing	No
2008-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-03-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

OHIC PPO 60713

Policy instance

Insurance contract or identification number	OHIC PPO 60713
Number of Individuals Covered	25
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $5,669
Welfare Benefit Premiums Paid to Carrier	USD $132,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,258

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	4
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	140
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $6,757
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $73,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,757
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

OHP CONTR 2102

Policy instance

Insurance contract or identification number	OHP CONTR 2102
Number of Individuals Covered	83
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $8,491
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $377,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,378
Insurance broker organization code?	3

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

Policy contract number

5989342

Policy instance

Insurance contract or identification number	5989342
Number of Individuals Covered	408
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $9,495
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,121
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	218
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $17,043
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $757,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,801

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

OHIC PPO 6079

Policy instance

Insurance contract or identification number	OHIC PPO 6079
Number of Individuals Covered	21
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $3,387
Welfare Benefit Premiums Paid to Carrier	USD $124,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,544
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713OOA

Policy instance

Insurance contract or identification number	60713OOA
Number of Individuals Covered	26
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	21
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $3,528
Welfare Benefit Premiums Paid to Carrier	USD $107,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,650
Insurance broker organization code?	3

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	125
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $5,461
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $76,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,461
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	72
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $8,979
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $338,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,744
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	29
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $6,303
Welfare Benefit Premiums Paid to Carrier	USD $159,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,734

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

Policy contract number

5989342

Policy instance

Insurance contract or identification number	5989342
Number of Individuals Covered	359
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $8,191
Total amount of fees paid to insurance company	USD $432
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,143
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	432

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	199
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $19,351
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $748,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,535

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713OOA

Policy instance

Insurance contract or identification number	60713OOA
Number of Individuals Covered	26
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $85,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	3
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	6
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	82
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $7,621
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $367,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,724

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	128
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $6,597
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $76,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,597

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

Policy contract number

5989342

Policy instance

Insurance contract or identification number	5989342
Number of Individuals Covered	349
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $7,061
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,296
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	186
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $13,633
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $669,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,240

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	20
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $2,455
Welfare Benefit Premiums Paid to Carrier	USD $82,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,844

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713OOA

Policy instance

Insurance contract or identification number	60713OOA
Number of Individuals Covered	7
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

R0755439

Policy instance

Insurance contract or identification number	R0755439
Number of Individuals Covered	144
Insurance policy start date	2019-11-01
Insurance policy end date	2020-10-31
Total amount of commissions paid to insurance broker	USD $3,001
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $931

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	31
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $4,162
Welfare Benefit Premiums Paid to Carrier	USD $162,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,126

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	5
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713OOA

Policy instance

Insurance contract or identification number	60713OOA
Number of Individuals Covered	9
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	14
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $2,171
Welfare Benefit Premiums Paid to Carrier	USD $73,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,631

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

Policy contract number

5989342

Policy instance

Insurance contract or identification number	5989342
Number of Individuals Covered	350
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $9,329
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,998
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	34
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $4,338
Welfare Benefit Premiums Paid to Carrier	USD $164,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,258

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	92
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-28
Total amount of commissions paid to insurance broker	USD $7,934
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $383,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,959

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	114
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $5,716
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $65,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,716

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	180
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $11,166
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $544,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,387

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102COBRA

Policy instance

Insurance contract or identification number	2102COBRA
Number of Individuals Covered	1
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	111
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $5,433
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $63,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,433

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	50
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $9,618
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $423,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,224

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077COBRA

Policy instance

Insurance contract or identification number	3077COBRA
Number of Individuals Covered	1
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	4
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713OOA

Policy instance

Insurance contract or identification number	60713OOA
Number of Individuals Covered	7
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	10
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $3,263
Welfare Benefit Premiums Paid to Carrier	USD $90,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,451

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	100
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $11,372
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $505,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,542

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

Policy contract number

5989342

Policy instance

Insurance contract or identification number	5989342
Number of Individuals Covered	344
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $7,495
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,495
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Welfare Benefit Premiums Paid to Carrier	USD $2,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	28
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $4,785
Welfare Benefit Premiums Paid to Carrier	USD $151,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,594

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077COBRA

Policy instance

Insurance contract or identification number	3077COBRA
Number of Individuals Covered	1
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	3077COBRA

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079OOA

Policy instance

Insurance contract or identification number	6079OOA
Number of Individuals Covered	3
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	6079COBRA - NONE

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	109
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $5,253
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $60,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,253
Insurance broker name	RAGAN B. PULLEY, JR

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	59
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $11,913
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $467,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,948
Insurance broker name	TFA BENEFITS - BROKER 26613

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102COBRA

Policy instance

Insurance contract or identification number	2102COBRA
Number of Individuals Covered	2
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	2102 COBRA

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	24
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $5,058
Welfare Benefit Premiums Paid to Carrier	USD $129,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,799
Insurance broker name	TFA BENEFITS - BROKER 15441

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	RGAN PULLY 26613

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

Policy contract number

TM05989342

Policy instance

Insurance contract or identification number	TM05989342
Number of Individuals Covered	361
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $7,527
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,527
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	RAGAN PULLEY

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	100
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $11,796
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $484,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,860
Insurance broker name	TFA BENEFITS - BROKER 15441

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	13
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $3,711
Welfare Benefit Premiums Paid to Carrier	USD $117,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,787
Insurance broker name	TFA BENEFITS - BROKER 15441

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713COBRA

Policy instance

Insurance contract or identification number	60713COBRA
Number of Individuals Covered	8
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	60713OOA - NONE

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	60
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $5,065
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $249,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,261
Insurance broker name	PULLEY

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

Policy contract number

TM05989342

Policy instance

Insurance contract or identification number	TM05989342
Number of Individuals Covered	257
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $7,519
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,519
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	RAGAN PULLEY

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Welfare Benefit Premiums Paid to Carrier	USD $5,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	18
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $2,222
Welfare Benefit Premiums Paid to Carrier	USD $98,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $553
Insurance broker name	PULLEY

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	242
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $13,334
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $622,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,319
Insurance broker name	TFA BENEFITS - BROKER 26613

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	18
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $3,489
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $868
Insurance broker name	PULLEY

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713COBRA

Policy instance

Insurance contract or identification number	60713COBRA
Number of Individuals Covered	2
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	99
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $4,516
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $49,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,516
Insurance broker name	RAGAN B. PULLEY, JR

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102COBRA

Policy instance

Insurance contract or identification number	2102COBRA
Number of Individuals Covered	1
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	2102 COBRA

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

Policy contract number

TM05989342

Policy instance

Insurance contract or identification number	TM05989342
Number of Individuals Covered	336
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $8,312
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $117,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,234
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THE FRIEDEN AGENCY LLC

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

60713

Policy instance

Insurance contract or identification number	60713
Number of Individuals Covered	11
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $873
Welfare Benefit Premiums Paid to Carrier	USD $35,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $217
Insurance broker name	PULLEY

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2012COBRA

Policy instance

Insurance contract or identification number	2012COBRA
Number of Individuals Covered	6
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	2102 COBRA

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	98
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $5,194
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $59,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,194
Insurance broker name	RAGAN B. PULLEY, JR

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

3077

Policy instance

Insurance contract or identification number	3077
Number of Individuals Covered	16
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $683
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $170
Insurance broker name	PULLEY

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	242
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $20,759
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $907,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,167
Insurance broker name	TFA BENEFITS - BROKER 26613

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	47
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $5,465
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $242,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,360
Insurance broker name	PULLEY

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Welfare Benefit Premiums Paid to Carrier	USD $2,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Welfare Benefit Premiums Paid to Carrier	USD $7,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	119
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $5,799
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) ADD
Welfare Benefit Premiums Paid to Carrier	USD $69,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,799
Insurance broker name	RAGAN B. PULLEY, JR

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	292
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $7,865
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,402,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,865
Insurance broker name	TFA BENEFITS

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2012COBRA

Policy instance

Insurance contract or identification number	2012COBRA
Number of Individuals Covered	1
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	66
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $2,278
Welfare Benefit Premiums Paid to Carrier	USD $399,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,278
Insurance broker name	TFA BENEFITS

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

Policy contract number

TM05989342

Policy instance

Insurance contract or identification number	TM05989342
Number of Individuals Covered	400
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $9,395
Total amount of fees paid to insurance company	USD $185
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,046
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	185
Insurance broker name	THE FRIEDEN AGENCY LLC

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

Policy contract number

TM05989342

Policy instance

Insurance contract or identification number	TM05989342
Number of Individuals Covered	418
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $7,840
Total amount of fees paid to insurance company	USD $942
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,880
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	942
Insurance broker name	THE FRIEDEN AGENCY LLC

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	306
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $31,195
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,378,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,764
Insurance broker name	PULLEY

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2012COBRA

Policy instance

Insurance contract or identification number	2012COBRA
Number of Individuals Covered	1
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	67
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $8,242
Welfare Benefit Premiums Paid to Carrier	USD $354,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,051
Insurance broker name	PULLEY

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Number of Individuals Covered	1
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Welfare Benefit Premiums Paid to Carrier	USD $11,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	129
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $5,752
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $68,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,752
Insurance broker name	RAGAN B. PULLEY, JR

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

Policy contract number

000000515365

Policy instance

Insurance contract or identification number	000000515365
Number of Individuals Covered	117
Insurance policy start date	2011-03-01
Insurance policy end date	2012-03-01
Total amount of commissions paid to insurance broker	USD $5,338
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $62,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

877491

Policy instance

Insurance contract or identification number	877491
Number of Individuals Covered	350
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $8,470
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2102

Policy instance

Insurance contract or identification number	2102
Number of Individuals Covered	208
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $22,530
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $966,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

2102COBRA

Policy instance

Insurance contract or identification number	2102COBRA
Number of Individuals Covered	2
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079

Policy instance

Insurance contract or identification number	6079
Number of Individuals Covered	50
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $5,552
Welfare Benefit Premiums Paid to Carrier	USD $242,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 )

Policy contract number

6079COBRA

Policy instance

Insurance contract or identification number	6079COBRA
Number of Individuals Covered	1
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-28
Welfare Benefit Premiums Paid to Carrier	USD $4,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MEB GENERAL CONTRACTORS, INC.
Employer identification number (EIN):	541194996
NAIC Classification:	237990
NAIC Description:	Other Heavy and Civil Engineering Construction

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1982-03-25
Company Identification Number:	0228139
Legal Registered Office Address:	4016 HOLLAND BOULEVARD CHESAPEAKE United States of America (USA) 23323