401k Plan data: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL plan

STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 401k Plan overview

Plan Name	STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL
Plan identification number	503

STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

STANLEY TOTAL LIVING CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: STANLEY TOTAL LIVING CENTER, INC.

Employer identification number (EIN): 561367400

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-07-01
503 2021-07-01
503 2020-07-01
503 2019-07-01
503 2018-07-01
503 2017-07-01 MIKE DIXON
503 2016-07-01 MIKE DIXON
503 2015-07-01 MIKE DIXON
503 2014-07-01 MIKE DIXON
503 2013-07-01 MIKE DIXON
503 2012-07-01 MIKE DIXON
503 2011-07-01 MIKE DIXON
503 2009-07-01 MIKE DIXON

Plan Statistics for STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL

401k plan membership statisitcs for STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL

Measure Date Value
2022: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2022 401k membership
Total participants, beginning-of-year 2022-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 100
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 100
2021: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2021 401k membership
Total participants, beginning-of-year 2021-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 102
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 2021-07-01 102
2020: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2020 401k membership
Total participants, beginning-of-year 2020-07-01 106
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 106
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 2020-07-01 106
2019: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2019 401k membership
Total participants, beginning-of-year 2019-07-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 106
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 2019-07-01 106
2018: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2018 401k membership
Total participants, beginning-of-year 2018-07-01 106
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 106
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 106
2017: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2017 401k membership
Total participants, beginning-of-year 2017-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 0
Number of retired or separated participants receiving benefits 2017-07-01 0
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 0
2016: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2016 401k membership
Total participants, beginning-of-year 2016-07-01 110
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 106
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 106
2015: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2015 401k membership
Total participants, beginning-of-year 2015-07-01 108
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 110
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 110
2014: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2014 401k membership
Total participants, beginning-of-year 2014-07-01 114
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 108
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 108
2013: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2013 401k membership
Total participants, beginning-of-year 2013-07-01 99
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 114
Total of all active and inactive participants 2013-07-01 114
2012: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2012 401k membership
Total participants, beginning-of-year 2012-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 99
Total of all active and inactive participants 2012-07-01 99
2011: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2011 401k membership
Total participants, beginning-of-year 2011-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 100
Total of all active and inactive participants 2011-07-01 100
2009: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2009 401k membership
Total participants, beginning-of-year 2009-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 122
Total of all active and inactive participants 2009-07-01 122

Measure	Date	Value
2022: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2022 401k membership
Total participants, beginning-of-year	2022-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	100
Number of retired or separated participants receiving benefits	2022-07-01	0
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	100
2021: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2021 401k membership
Total participants, beginning-of-year	2021-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	102
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	102
2020: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2020 401k membership
Total participants, beginning-of-year	2020-07-01	106
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	106
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	106
2019: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2019 401k membership
Total participants, beginning-of-year	2019-07-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	106
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	106
2018: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2018 401k membership
Total participants, beginning-of-year	2018-07-01	106
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	106
Number of retired or separated participants receiving benefits	2018-07-01	0
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	106
2017: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2017 401k membership
Total participants, beginning-of-year	2017-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	0
Number of retired or separated participants receiving benefits	2017-07-01	0
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	0
2016: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2016 401k membership
Total participants, beginning-of-year	2016-07-01	110
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	106
Number of retired or separated participants receiving benefits	2016-07-01	0
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	106
2015: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2015 401k membership
Total participants, beginning-of-year	2015-07-01	108
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	110
Number of retired or separated participants receiving benefits	2015-07-01	0
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	110
2014: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2014 401k membership
Total participants, beginning-of-year	2014-07-01	114
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	108
Number of retired or separated participants receiving benefits	2014-07-01	0
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	108
2013: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2013 401k membership
Total participants, beginning-of-year	2013-07-01	99
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	114
Total of all active and inactive participants	2013-07-01	114
2012: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2012 401k membership
Total participants, beginning-of-year	2012-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	99
Total of all active and inactive participants	2012-07-01	99
2011: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2011 401k membership
Total participants, beginning-of-year	2011-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	100
Total of all active and inactive participants	2011-07-01	100
2009: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2009 401k membership
Total participants, beginning-of-year	2009-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	122
Total of all active and inactive participants	2009-07-01	122

Form 5500 Responses for STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL

2022: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	Yes
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2009: STANLEY TOTAL LIVING CENTER, INC. MANAGED MEDICAL 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1118099

Policy instance

Insurance contract or identification number	1118099
Number of Individuals Covered	100
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,140
Total amount of fees paid to insurance company	USD $779
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,140
Amount paid for insurance broker fees	779

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

14175518-1001

Policy instance

Insurance contract or identification number	14175518-1001
Number of Individuals Covered	97
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $26,405
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $735,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,405
Additional information about fees paid to insurance broker	MEDICAL BENEFITS
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	96
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $11,863
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS,LIFE
Welfare Benefit Premiums Paid to Carrier	USD $87,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,863
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	102
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $10,164
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS,LIFE
Welfare Benefit Premiums Paid to Carrier	USD $82,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,164
Insurance broker organization code?	3

FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )

Policy contract number

221200

Policy instance

Insurance contract or identification number	221200
Number of Individuals Covered	99
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $32,324
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $788,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,324
Additional information about fees paid to insurance broker	MEDICAL BENEFITS
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

5488567

Policy instance

Insurance contract or identification number	5488567
Number of Individuals Covered	14
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,646
Total amount of fees paid to insurance company	USD $1,591
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,646
Amount paid for insurance broker fees	1591

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	102
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $10,827
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS,LIFE
Welfare Benefit Premiums Paid to Carrier	USD $82,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,827
Insurance broker organization code?	3

FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )

Policy contract number

221200

Policy instance

Insurance contract or identification number	221200
Number of Individuals Covered	106
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $33,261
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $831,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,261
Insurance broker organization code?	3

FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )

Policy contract number

221200

Policy instance

Insurance contract or identification number	221200
Number of Individuals Covered	106
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $31,709
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $774,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,709
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	123
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $11,244
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS,LIFE
Welfare Benefit Premiums Paid to Carrier	USD $84,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,244
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	123
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $11,244
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS,LIFE
Welfare Benefit Premiums Paid to Carrier	USD $84,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,244
Insurance broker organization code?	3

FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )

Policy contract number

221200

Policy instance

Insurance contract or identification number	221200
Number of Individuals Covered	106
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $29,920
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $747,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,920
Insurance broker organization code?	3

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

Policy contract number

000010213572

Policy instance

Insurance contract or identification number	000010213572
Number of Individuals Covered	86
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,358
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,358
Insurance broker organization code?	4

FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )

Policy contract number

221200

Policy instance

Insurance contract or identification number	221200
Number of Individuals Covered	106
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $25,667
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $641,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,667
Insurance broker organization code?	3
Insurance broker name	ELECTRO MEDICAL SERVICES, INC

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

934

Policy instance

Insurance contract or identification number	934
Number of Individuals Covered	113
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $636
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $636
Insurance broker organization code?	3
Insurance broker name	EBENCONCEPTS COMPANY

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	129
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $9,809
Other welfare benefits provided	AD & D, DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $70,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,692
Insurance broker organization code?	3
Insurance broker name	CONSOLIDATED PLANNING HLD

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

Policy contract number

000010213572

Policy instance

Insurance contract or identification number	000010213572
Number of Individuals Covered	80
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,700
Total amount of fees paid to insurance company	USD $106
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,700
Amount paid for insurance broker fees	106
Insurance broker organization code?	4
Insurance broker name	EBENCONCEPTS CO

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

934

Policy instance

Insurance contract or identification number	934
Number of Individuals Covered	133
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $617
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $617
Insurance broker name	EBENCONCEPTS COMPANY

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

Policy contract number

000010213572

Policy instance

Insurance contract or identification number	000010213572
Number of Individuals Covered	73
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,921
Total amount of fees paid to insurance company	USD $478
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,804
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	478
Insurance broker name	EBONCONCEPTS CO

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521774

Policy instance

Insurance contract or identification number	00521774
Number of Individuals Covered	108
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $3,013
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $20,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,013
Insurance broker name	EBENCONCEPTS COMPANY

COVENTRY HEALTH CARE OF CAROLINAS, INC. (National Association of Insurance Commissioners NAIC id number: 95321 )

Policy contract number

318651/652/654

Policy instance

Insurance contract or identification number	318651/652/654
Number of Individuals Covered	110
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $23,324
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $466,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,212
Insurance broker name	THE HAYES GROUP, INC

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

41061

Policy instance

Insurance contract or identification number	41061
Number of Individuals Covered	80
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,528
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,143
Insurance broker name	IBSI HOLDINGS, INC

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

Policy contract number

61B965

Policy instance

Insurance contract or identification number	61B965
Number of Individuals Covered	95
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,036
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,036
Insurance broker name	THE HAYES GROUP, INC

COVENTRY HEALTH CARE OF CAROLINAS, INC. (National Association of Insurance Commissioners NAIC id number: 95321 )

Policy contract number

3183651/3183654

Policy instance

Insurance contract or identification number	3183651/3183654
Number of Individuals Covered	108
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $24,677
Total amount of fees paid to insurance company	USD $750
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $493,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	750
Commission paid to Insurance Broker	USD $24,677
Insurance broker name	THE HAYES GROUP, INC

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

41061

Policy instance

Insurance contract or identification number	41061
Number of Individuals Covered	104
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,387
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,236
Insurance broker name	IBSI HOLDINGS, INC

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

Policy contract number

010-503616

Policy instance

Insurance contract or identification number	010-503616
Number of Individuals Covered	99
Insurance policy end date	2014-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

41061

Policy instance

Insurance contract or identification number	41061
Number of Individuals Covered	115
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $4,151
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,063
Insurance broker name	IBSI HOLDINGS, INC

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

3183650000

Policy instance

Insurance contract or identification number	3183650000
Number of Individuals Covered	13
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $1,486
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,486
Insurance broker name	GROUP BENEFITS SOLUTIONS, INC

COVENTRY HEALTH CARE OF CAROLINAS, INC. (National Association of Insurance Commissioners NAIC id number: 95321 )

Policy contract number

3183651/3183652

Policy instance

Insurance contract or identification number	3183651/3183652
Number of Individuals Covered	114
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $32,224
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $335,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,750
Insurance broker name	GROUP BENEFIT SOLUTIONS, INC

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

066243

Policy instance

Insurance contract or identification number	066243
Number of Individuals Covered	91
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $23,914
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,914
Insurance broker name	BRIAN FLYNN

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50004008

Policy instance

Insurance contract or identification number	50004008
Number of Individuals Covered	99
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,898
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,723
Insurance broker name	SAEGIS BENEFITS

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

HS368

Policy instance

Insurance contract or identification number	HS368
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,736
Total amount of fees paid to insurance company	USD $65
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

066243

Policy instance

Insurance contract or identification number	066243
Number of Individuals Covered	100
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $25,909
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

115904

Policy instance

Insurance contract or identification number	115904
Number of Individuals Covered	99
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $7,578
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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

400001000 09762

Policy instance

Insurance contract or identification number	400001000 09762
Insurance policy start date	2010-07-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $754
Total amount of fees paid to insurance company	USD $217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )

Policy contract number

9299N6

Policy instance

Insurance contract or identification number	9299N6
Number of Individuals Covered	107
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $20,848
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

115904

Policy instance

Insurance contract or identification number	115904
Number of Individuals Covered	110
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $675
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

066243

Policy instance

Insurance contract or identification number	066243
Number of Individuals Covered	113
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $24,623
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	STANLEY TOTAL LIVING CENTER, INC.
Employer identification number (EIN):	561367400
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities