401k Plan data: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN plan

LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN
Plan identification number	505

LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

LAKE HIGHLAND PREPARATORY SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: LAKE HIGHLAND PREPARATORY SCHOOL

Employer identification number (EIN): 590624431

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2021-07-01 JESSIE MARTINEZ 2023-03-23 JESSIE MARTINEZ 2023-03-23
505 2020-07-01 JESSIE MARTINEZ 2022-03-30 JESSIE MARTINEZ 2022-03-30
505 2019-07-01 JAMES W. BARTLETT 2021-04-12 JAMES W. BARTLETT 2021-04-12
505 2018-07-01 JAMES W. BARTLETT 2020-04-17 JAMES W. BARTLETT 2020-04-17
505 2017-07-01 JAMES W. BARTLETT 2019-04-09 JAMES W. BARTLETT 2019-04-09
505 2016-07-01
505 2015-07-01
505 2014-07-01
505 2013-07-01
505 2012-07-01 JAMES W. BARTLETT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2021-07-01	JESSIE MARTINEZ	2023-03-23	JESSIE MARTINEZ	2023-03-23
505	2020-07-01	JESSIE MARTINEZ	2022-03-30	JESSIE MARTINEZ	2022-03-30
505	2019-07-01	JAMES W. BARTLETT	2021-04-12	JAMES W. BARTLETT	2021-04-12
505	2018-07-01	JAMES W. BARTLETT	2020-04-17	JAMES W. BARTLETT	2020-04-17
505	2017-07-01	JAMES W. BARTLETT	2019-04-09	JAMES W. BARTLETT	2019-04-09
505	2016-07-01
505	2015-07-01
505	2014-07-01
505	2013-07-01
505	2012-07-01	JAMES W. BARTLETT

Plan Statistics for LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN

401k plan membership statisitcs for LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN

Measure Date Value
2021: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 303
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 308
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 2021-07-01 308
2020: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 294
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 303
Total of all active and inactive participants 2020-07-01 303
2019: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 309
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 294
Number of retired or separated participants receiving benefits 2019-07-01 2
Total of all active and inactive participants 2019-07-01 296
2018: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 295
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 309
Total of all active and inactive participants 2018-07-01 309
2017: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 295
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 295
Total of all active and inactive participants 2017-07-01 295
2016: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 294
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 295
Total of all active and inactive participants 2016-07-01 295
2015: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 291
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 294
Total of all active and inactive participants 2015-07-01 294
2014: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 290
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 291
Total of all active and inactive participants 2014-07-01 291
2013: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 291
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 290
Total of all active and inactive participants 2013-07-01 290
2012: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 286
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 275
Number of retired or separated participants receiving benefits 2012-07-01 16
Total of all active and inactive participants 2012-07-01 291

Measure	Date	Value
2021: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	303
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	308
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	308
2020: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	294
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	303
Total of all active and inactive participants	2020-07-01	303
2019: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	309
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	294
Number of retired or separated participants receiving benefits	2019-07-01	2
Total of all active and inactive participants	2019-07-01	296
2018: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	295
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	309
Total of all active and inactive participants	2018-07-01	309
2017: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	295
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	295
Total of all active and inactive participants	2017-07-01	295
2016: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	294
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	295
Total of all active and inactive participants	2016-07-01	295
2015: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	291
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	294
Total of all active and inactive participants	2015-07-01	294
2014: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	290
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	291
Total of all active and inactive participants	2014-07-01	291
2013: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	291
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	290
Total of all active and inactive participants	2013-07-01	290
2012: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	286
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	275
Number of retired or separated participants receiving benefits	2012-07-01	16
Total of all active and inactive participants	2012-07-01	291

Form 5500 Responses for LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN

2021: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LAKE HIGHLAND PREPARATORY SCHOOL WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	First time form 5500 has been submitted	Yes
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

169069

Policy instance

Insurance contract or identification number	169069
Number of Individuals Covered	334
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

169069

Policy instance

Insurance contract or identification number	169069
Number of Individuals Covered	334
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $5,256
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,503
Insurance broker organization code?	3

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

Policy contract number

0622579

Policy instance

Insurance contract or identification number	0622579
Number of Individuals Covered	226
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,014
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,014
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	183
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $17,522
Total amount of fees paid to insurance company	USD $210
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $136,728
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	170
Additional information about fees paid to insurance broker	OTHER COMPENSATION

AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )

Policy contract number

21AN02B799

Policy instance

Insurance contract or identification number	21AN02B799
Number of Individuals Covered	306
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $90,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $761,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	90000
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

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

Policy contract number

FLX968991

Policy instance

Insurance contract or identification number	FLX968991
Number of Individuals Covered	324
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,677
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	3677
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	184
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $18,892
Total amount of fees paid to insurance company	USD $797
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $155,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,617
Amount paid for insurance broker fees	454
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

OK970450

Policy instance

Insurance contract or identification number	OK970450
Number of Individuals Covered	324
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $309
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	309
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

LK966012

Policy instance

Insurance contract or identification number	LK966012
Number of Individuals Covered	324
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,508
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1508
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0622579

Policy instance

Insurance contract or identification number	0622579
Number of Individuals Covered	218
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $656
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	656
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

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

Policy contract number

00622579

Policy instance

Insurance contract or identification number	00622579
Number of Individuals Covered	331
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,828
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $739,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	4828
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

00622579

Policy instance

Insurance contract or identification number	00622579
Number of Individuals Covered	335
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $9,004
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $700,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	9004
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

FLX968991

Policy instance

Insurance contract or identification number	FLX968991
Number of Individuals Covered	317
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	202
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $21,927
Total amount of fees paid to insurance company	USD $929
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $145,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,359
Amount paid for insurance broker fees	458
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

OK970450

Policy instance

Insurance contract or identification number	OK970450
Number of Individuals Covered	317
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK966012

Policy instance

Insurance contract or identification number	LK966012
Number of Individuals Covered	317
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00622579

Policy instance

Insurance contract or identification number	00622579
Number of Individuals Covered	326
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $674,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	219
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $25,613
Total amount of fees paid to insurance company	USD $1,123
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $164,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,646
Amount paid for insurance broker fees	163
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	309
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,744
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1744
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	309
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,046
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $42,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2046
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	111
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,557
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $32,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1557
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

519424HNO

Policy instance

Insurance contract or identification number	519424HNO
Number of Individuals Covered	355
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $2,617,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	219
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $26,534
Total amount of fees paid to insurance company	USD $698
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $156,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	295
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,583
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	295
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,342
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	109
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,165
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $30,581
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

0519424

Policy instance

Insurance contract or identification number	0519424
Number of Individuals Covered	338
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,317
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

0519424

Policy instance

Insurance contract or identification number	0519424
Number of Individuals Covered	323
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,299
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1299
Additional information about fees paid to insurance broker	2014/2015 PPP ENGAGEMENT CREDIT
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS3223

Policy instance

Insurance contract or identification number	VS3223
Number of Individuals Covered	131
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	101
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,087
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $24,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1087
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	294
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,425
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1425
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	294
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,424
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $34,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1424
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	204
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $21,363
Total amount of fees paid to insurance company	USD $696
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $124,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,201
Amount paid for insurance broker fees	62
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	NORMAN TRAHAN

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

519424HNO

Policy instance

Insurance contract or identification number	519424HNO
Number of Individuals Covered	340
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,723
Welfare Benefit Premiums Paid to Carrier	USD $2,390,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5723
Additional information about fees paid to insurance broker	2014/2015 PPP ENGAGEMENT CREDIT
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

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

Policy contract number

0519424

Policy instance

Insurance contract or identification number	0519424
Number of Individuals Covered	310
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

519424HNO

Policy instance

Insurance contract or identification number	519424HNO
Number of Individuals Covered	334
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $2,347,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	210
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $22,277
Total amount of fees paid to insurance company	USD $354
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $128,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,313
Amount paid for insurance broker fees	141
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	DENA MARIE COLE

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	291
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,289
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1289
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	291
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,401
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1401
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	97
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,004
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $23,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1004
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS3223

Policy instance

Insurance contract or identification number	VS3223
Number of Individuals Covered	122
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,832
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

519424

Policy instance

Insurance contract or identification number	519424
Number of Individuals Covered	329
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

519424HNO

Policy instance

Insurance contract or identification number	519424HNO
Number of Individuals Covered	349
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $2,193,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Number of Individuals Covered	206
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $21,529
Total amount of fees paid to insurance company	USD $118
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $135,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,423
Amount paid for insurance broker fees	73
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	J.W. GRIMES, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	290
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $773
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	773
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	290
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $838
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	838
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	92
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $569
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	569
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS3223

Policy instance

Insurance contract or identification number	VS3223
Number of Individuals Covered	131
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS3223

Policy instance

Insurance contract or identification number	VS3223
Number of Individuals Covered	119
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,142
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $998
Amount paid for insurance broker fees	0
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	82
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,951
Total amount of fees paid to insurance company	USD $813
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,667
Amount paid for insurance broker fees	813
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

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

Policy contract number

519424

Policy instance

Insurance contract or identification number	519424
Number of Individuals Covered	319
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,008
Total amount of fees paid to insurance company	USD $313
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,172
Amount paid for insurance broker fees	313
Additional information about fees paid to insurance broker	PM CROSS-SALE
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	285
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,649
Total amount of fees paid to insurance company	USD $1,134
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,268
Amount paid for insurance broker fees	1134
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

H3082

Policy instance

Insurance contract or identification number	H3082
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $16,355
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $115,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,032
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	LESLIE K. KIMBROUGH

AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )

Policy contract number

519424-HNO

Policy instance

Insurance contract or identification number	519424-HNO
Number of Individuals Covered	362
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $33,897
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $1,864,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,052
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ADYF

Policy instance

Insurance contract or identification number	G000ADYF
Number of Individuals Covered	285
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,028
Total amount of fees paid to insurance company	USD $1,298
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,592
Amount paid for insurance broker fees	1298
Additional information about fees paid to insurance broker	OTHER COMPESATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF FLORIDA, INC.

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LAKE HIGHLANDS DENTAL PROFIT SHARING PLAN [EIN = 752247505]

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Company Name:	LAKE HIGHLAND PREPARATORY SCHOOL
Employer identification number (EIN):	590624431
NAIC Classification:	611000