401k Plan data: LYNCH MANAGEMENT WELFARE PLAN plan

LYNCH MANAGEMENT WELFARE PLAN 401k Plan overview

Plan Name	LYNCH MANAGEMENT WELFARE PLAN
Plan identification number	501

LYNCH MANAGEMENT WELFARE 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

LYNCH MANAGEMENT GROUP has sponsored the creation of one or more 401k plans.

Company Name: LYNCH MANAGEMENT GROUP

Employer identification number (EIN): 592607387

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LYNCH MANAGEMENT WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-10-01
501 2021-10-01
501 2020-10-01
501 2018-10-01
501 2017-10-01
501 2016-10-01 GLENN WRIGHT
501 2015-10-01 GLENN WRIGHT
501 2014-10-01 GLENN WRIGHT
501 2013-10-01 GLENN WRIGHT
501 2012-10-01 GLENN WRIGHT
501 2011-10-01 GLENN WRIGHT
501 2009-10-01 GLENN WRIGHT
501 2009-10-01 GLENN WRIGHT

Plan Statistics for LYNCH MANAGEMENT WELFARE PLAN

401k plan membership statisitcs for LYNCH MANAGEMENT WELFARE PLAN

Measure Date Value
2022: LYNCH MANAGEMENT WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 143
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 146
Total of all active and inactive participants 2022-10-01 146
2021: LYNCH MANAGEMENT WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 131
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 143
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 143
2020: LYNCH MANAGEMENT WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 157
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 131
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 131
2018: LYNCH MANAGEMENT WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 191
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 182
Total of all active and inactive participants 2018-10-01 182
Total participants 2018-10-01 182
2017: LYNCH MANAGEMENT WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 182
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 191
Total of all active and inactive participants 2017-10-01 191
Total participants 2017-10-01 191
2016: LYNCH MANAGEMENT WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 109
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 182
Total of all active and inactive participants 2016-10-01 182
Total participants 2016-10-01 182
2015: LYNCH MANAGEMENT WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 108
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 119
Total of all active and inactive participants 2015-10-01 119
Total participants 2015-10-01 0
2014: LYNCH MANAGEMENT WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 97
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 108
Total of all active and inactive participants 2014-10-01 108
Total participants 2014-10-01 0
2013: LYNCH MANAGEMENT WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 99
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 97
Total of all active and inactive participants 2013-10-01 97
Total participants 2013-10-01 0
2012: LYNCH MANAGEMENT WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 92
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 99
Total of all active and inactive participants 2012-10-01 99
Total participants 2012-10-01 0
2011: LYNCH MANAGEMENT WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 84
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 92
Total of all active and inactive participants 2011-10-01 92
Total participants 2011-10-01 92
2009: LYNCH MANAGEMENT WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 92
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 92
Total of all active and inactive participants 2009-10-01 92
Total participants 2009-10-01 92

Measure	Date	Value
2022: LYNCH MANAGEMENT WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	143
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	146
Total of all active and inactive participants	2022-10-01	146
2021: LYNCH MANAGEMENT WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	131
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	143
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	143
2020: LYNCH MANAGEMENT WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	157
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	131
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	131
2018: LYNCH MANAGEMENT WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	191
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	182
Total of all active and inactive participants	2018-10-01	182
Total participants	2018-10-01	182
2017: LYNCH MANAGEMENT WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	182
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	191
Total of all active and inactive participants	2017-10-01	191
Total participants	2017-10-01	191
2016: LYNCH MANAGEMENT WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	109
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	182
Total of all active and inactive participants	2016-10-01	182
Total participants	2016-10-01	182
2015: LYNCH MANAGEMENT WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	108
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	119
Total of all active and inactive participants	2015-10-01	119
Total participants	2015-10-01	0
2014: LYNCH MANAGEMENT WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	97
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	108
Total of all active and inactive participants	2014-10-01	108
Total participants	2014-10-01	0
2013: LYNCH MANAGEMENT WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	99
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	97
Total of all active and inactive participants	2013-10-01	97
Total participants	2013-10-01	0
2012: LYNCH MANAGEMENT WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	92
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	99
Total of all active and inactive participants	2012-10-01	99
Total participants	2012-10-01	0
2011: LYNCH MANAGEMENT WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	84
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	92
Total of all active and inactive participants	2011-10-01	92
Total participants	2011-10-01	92
2009: LYNCH MANAGEMENT WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	92
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	92
Total of all active and inactive participants	2009-10-01	92
Total participants	2009-10-01	92

Financial Data on LYNCH MANAGEMENT WELFARE PLAN

Measure	Date	Value
2018 : LYNCH MANAGEMENT WELFARE PLAN 2018 401k financial data
Value of total assets at end of year	2018-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-09-30	No
Was this plan covered by a fidelity bond	2018-09-30	No
If this is an individual account plan, was there a blackout period	2018-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2018-09-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-09-30	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-09-30	No
Were any leases to which the plan was party in default or uncollectible	2018-09-30	No
Value of interest in common/collective trusts at end of year	2018-09-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-09-30	No
Was there a failure to transmit to the plan any participant contributions	2018-09-30	No
Has the plan failed to provide any benefit when due under the plan	2018-09-30	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-09-30	No
Did the plan have assets held for investment	2018-09-30	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-09-30	No
Opinion of an independent qualified public accountant for this plan	2018-09-30	Qualified
Accountancy firm name	2018-09-30	S. MARK HAND & ASSOCIATES
Accountancy firm EIN	2018-09-30	010551831
2017 : LYNCH MANAGEMENT WELFARE PLAN 2017 401k financial data
Value of total assets at end of year	2017-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-09-30	No
Was this plan covered by a fidelity bond	2017-09-30	No
If this is an individual account plan, was there a blackout period	2017-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-09-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-09-30	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-09-30	No
Were any leases to which the plan was party in default or uncollectible	2017-09-30	No
Value of interest in common/collective trusts at end of year	2017-09-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-09-30	No
Was there a failure to transmit to the plan any participant contributions	2017-09-30	No
Has the plan failed to provide any benefit when due under the plan	2017-09-30	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-09-30	No
Did the plan have assets held for investment	2017-09-30	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-09-30	No
Opinion of an independent qualified public accountant for this plan	2017-09-30	Qualified
Accountancy firm name	2017-09-30	S. MARK HAND & ASSOCIATES
Accountancy firm EIN	2017-09-30	010551831
2016 : LYNCH MANAGEMENT WELFARE PLAN 2016 401k financial data
Value of total assets at end of year	2016-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-09-30	No
Was this plan covered by a fidelity bond	2016-09-30	No
If this is an individual account plan, was there a blackout period	2016-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2016-09-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-09-30	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-09-30	No
Were any leases to which the plan was party in default or uncollectible	2016-09-30	No
Value of interest in common/collective trusts at end of year	2016-09-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-09-30	No
Was there a failure to transmit to the plan any participant contributions	2016-09-30	No
Has the plan failed to provide any benefit when due under the plan	2016-09-30	No
Did the plan have assets held for investment	2016-09-30	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-09-30	No
Opinion of an independent qualified public accountant for this plan	2016-09-30	Qualified
Accountancy firm name	2016-09-30	S. MARK HAND & ASSOCIATES
Accountancy firm EIN	2016-09-30	010551831

Form 5500 Responses for LYNCH MANAGEMENT WELFARE PLAN

2022: LYNCH MANAGEMENT WELFARE PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: LYNCH MANAGEMENT WELFARE PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: LYNCH MANAGEMENT WELFARE PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: LYNCH MANAGEMENT WELFARE PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LYNCH MANAGEMENT WELFARE PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LYNCH MANAGEMENT WELFARE PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LYNCH MANAGEMENT WELFARE PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LYNCH MANAGEMENT WELFARE PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LYNCH MANAGEMENT WELFARE PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LYNCH MANAGEMENT WELFARE PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: LYNCH MANAGEMENT WELFARE PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: LYNCH MANAGEMENT WELFARE PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

43992

Policy instance

Insurance contract or identification number	43992
Number of Individuals Covered	53
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $3,607
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,128
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	146
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $52,864
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $352,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,864
Insurance broker organization code?	3

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

Policy contract number

5591389

Policy instance

Insurance contract or identification number	5591389
Number of Individuals Covered	257
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $10,575
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 $90,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,575
Insurance broker organization code?	3

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

Policy contract number

50046129

Policy instance

Insurance contract or identification number	50046129
Number of Individuals Covered	889
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $5,335
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $169,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,559
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

32502

Policy instance

Insurance contract or identification number	32502
Number of Individuals Covered	28
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $494
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $318
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95875

Policy instance

Insurance contract or identification number	95875
Number of Individuals Covered	21
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $1,120
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $860
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95877

Policy instance

Insurance contract or identification number	95877
Number of Individuals Covered	22
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $1,251
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,020
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95876

Policy instance

Insurance contract or identification number	95876
Number of Individuals Covered	27
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $1,239
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,066
Insurance broker organization code?	3

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

Policy contract number

5591389

Policy instance

Insurance contract or identification number	5591389
Number of Individuals Covered	249
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $9,172
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,172
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	143
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $53,651
Welfare Benefit Premiums Paid to Carrier	USD $359,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,651
Insurance broker organization code?	3

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

Policy contract number

50046129

Policy instance

Insurance contract or identification number	50046129
Number of Individuals Covered	896
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $23,206
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $134,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,903
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

32502

Policy instance

Insurance contract or identification number	32502
Number of Individuals Covered	26
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $862
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $560
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95875

Policy instance

Insurance contract or identification number	95875
Number of Individuals Covered	20
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,364
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,080
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95877

Policy instance

Insurance contract or identification number	95877
Number of Individuals Covered	15
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,081
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $728
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95876

Policy instance

Insurance contract or identification number	95876
Number of Individuals Covered	26
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,342
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,081
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

43992

Policy instance

Insurance contract or identification number	43992
Number of Individuals Covered	57
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,784
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,286
Insurance broker organization code?	3

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

Policy contract number

5591389

Policy instance

Insurance contract or identification number	5591389
Number of Individuals Covered	342
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $10,380
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,380
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	131
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $47,372
Welfare Benefit Premiums Paid to Carrier	USD $338,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,372
Insurance broker organization code?	3

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

Policy contract number

VDT601851

Policy instance

Insurance contract or identification number	VDT601851
Number of Individuals Covered	115
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $5,125
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,125
Insurance broker organization code?	3

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

Policy contract number

VDT601852

Policy instance

Insurance contract or identification number	VDT601852
Number of Individuals Covered	97
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $8,926
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,926
Insurance broker organization code?	3

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

Policy contract number

SOK605635

Policy instance

Insurance contract or identification number	SOK605635
Number of Individuals Covered	237
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,250
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,250
Insurance broker organization code?	3

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

Policy contract number

SGM607743

Policy instance

Insurance contract or identification number	SGM607743
Number of Individuals Covered	48
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $7,257
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,257
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

32502

Policy instance

Insurance contract or identification number	32502
Number of Individuals Covered	29
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $800
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $498
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95875

Policy instance

Insurance contract or identification number	95875
Number of Individuals Covered	17
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $584
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $302
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95877

Policy instance

Insurance contract or identification number	95877
Number of Individuals Covered	25
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,222
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $629
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95876

Policy instance

Insurance contract or identification number	95876
Number of Individuals Covered	19
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $632
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $332
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

43992

Policy instance

Insurance contract or identification number	43992
Number of Individuals Covered	54
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $2,575
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,021
Insurance broker organization code?	3

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

Policy contract number

5591389

Policy instance

Insurance contract or identification number	5591389
Number of Individuals Covered	391
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $12,555
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,555

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	182
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $53,799
Welfare Benefit Premiums Paid to Carrier	USD $358,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,799
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	23
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $8,799
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,799
Insurance broker organization code?	3

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

Policy contract number

VDT601851

Policy instance

Insurance contract or identification number	VDT601851
Insurance policy start date	2018-10-01
Insurance policy end date	2019-10-01
Total amount of commissions paid to insurance broker	USD $5,168
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,168
Insurance broker organization code?	3

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

Policy contract number

SOK605635

Policy instance

Insurance contract or identification number	SOK605635
Insurance policy start date	2018-10-01
Insurance policy end date	2019-10-01
Total amount of commissions paid to insurance broker	USD $1,107
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,107
Insurance broker organization code?	3

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

Policy contract number

VDT601852

Policy instance

Insurance contract or identification number	VDT601852
Insurance policy start date	2018-10-01
Insurance policy end date	2019-10-01
Total amount of commissions paid to insurance broker	USD $9,879
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,879
Insurance broker organization code?	3

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

Policy contract number

SGM607743

Policy instance

Insurance contract or identification number	SGM607743
Insurance policy start date	2018-10-01
Insurance policy end date	2019-10-01
Total amount of commissions paid to insurance broker	USD $7,608
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,608
Insurance broker organization code?	3

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

Policy contract number

SGM607743

Policy instance

Insurance contract or identification number	SGM607743
Insurance policy start date	2017-10-01
Insurance policy end date	2018-10-01
Total amount of commissions paid to insurance broker	USD $6,490
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,270
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

VDT601852

Policy instance

Insurance contract or identification number	VDT601852
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $8,708
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,056
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

SOK605635

Policy instance

Insurance contract or identification number	SOK605635
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $896
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,974
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

VDT601851

Policy instance

Insurance contract or identification number	VDT601851
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $4,674
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	18
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $8,884
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	186
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $54,406
Welfare Benefit Premiums Paid to Carrier	USD $362,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

TM05591389

Policy instance

Insurance contract or identification number	TM05591389
Number of Individuals Covered	457
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $14,964
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,642
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

000010181328

Policy instance

Insurance contract or identification number	000010181328
Number of Individuals Covered	92
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,033
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $20,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,033
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

055-3045-10

Policy instance

Insurance contract or identification number	055-3045-10
Number of Individuals Covered	67
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $939
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $939
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

64594

Policy instance

Insurance contract or identification number	64594
Number of Individuals Covered	108
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $9,611
Total amount of fees paid to insurance company	USD $84,507
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 $9,611
Amount paid for insurance broker fees	84507
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	64
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,538
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,538
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	108
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $28,579
Welfare Benefit Premiums Paid to Carrier	USD $190,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,579
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

TM05591389

Policy instance

Insurance contract or identification number	TM05591389
Number of Individuals Covered	133
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $6,035
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,035
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )

Policy contract number

VS2088

Policy instance

Insurance contract or identification number	VS2088
Number of Individuals Covered	83
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $1,101
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,101
Insurance broker organization code?	3
Insurance broker name	PIERCE DWIGHT-RICHTER

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

Policy contract number

000400181327

Policy instance

Insurance contract or identification number	000400181327
Number of Individuals Covered	74
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $5,784
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $38,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,784
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

000010181326

Policy instance

Insurance contract or identification number	000010181326
Number of Individuals Covered	91
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $5,588
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,588
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

64594

Policy instance

Insurance contract or identification number	64594
Number of Individuals Covered	97
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $9,160
Total amount of fees paid to insurance company	USD $76,794
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 $9,160
Amount paid for insurance broker fees	76794
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

055-3045-01

Policy instance

Insurance contract or identification number	055-3045-01
Number of Individuals Covered	67
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $309
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $309
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	70
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $3,662
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,662
Insurance broker organization code?	3
Insurance broker name	SEE ATTACHED

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

Policy contract number

TM05591389

Policy instance

Insurance contract or identification number	TM05591389
Number of Individuals Covered	169
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $5,367
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,367
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

055-3045-10

Policy instance

Insurance contract or identification number	055-3045-10
Number of Individuals Covered	104
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $418
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $418
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

000010181328

Policy instance

Insurance contract or identification number	000010181328
Number of Individuals Covered	90
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,813
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $18,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,813
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

000400181327

Policy instance

Insurance contract or identification number	000400181327
Number of Individuals Covered	221
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,758
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $45,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,758
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

000010181326

Policy instance

Insurance contract or identification number	000010181326
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,747
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,747
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )

Policy contract number

VS2088

Policy instance

Insurance contract or identification number	VS2088
Number of Individuals Covered	65
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $943
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $943
Insurance broker organization code?	3
Insurance broker name	PIERCE DWIGHT-RICHTER

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	97
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $20,333
Welfare Benefit Premiums Paid to Carrier	USD $135,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,333
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )

Policy contract number

VS2088

Policy instance

Insurance contract or identification number	VS2088
Number of Individuals Covered	65
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $957
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $957
Insurance broker organization code?	3
Insurance broker name	PIERCE DWIGHT-RICHTER

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

Policy contract number

TM05591389

Policy instance

Insurance contract or identification number	TM05591389
Number of Individuals Covered	160
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $5,983
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,983
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

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

Policy contract number

850642G

Policy instance

Insurance contract or identification number	850642G
Number of Individuals Covered	272
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $11,148
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,148
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	99
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $25,223
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,223
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

055-3045-01

Policy instance

Insurance contract or identification number	055-3045-01
Number of Individuals Covered	41
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $846
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $846
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	81
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $10,092
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,092
Insurance broker organization code?	3
Insurance broker name	SEE ATTACHED

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

64594

Policy instance

Insurance contract or identification number	64594
Number of Individuals Covered	99
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $8,529
Total amount of fees paid to insurance company	USD $71,485
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 $8,529
Amount paid for insurance broker fees	71485
Insurance broker organization code?	3
Insurance broker name	BENEFITS TECHNOLOGIES DIVISION

HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )

Policy contract number

VS2088

Policy instance

Insurance contract or identification number	VS2088
Number of Individuals Covered	57
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $741
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

TM05591389

Policy instance

Insurance contract or identification number	TM05591389
Number of Individuals Covered	159
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $5,312
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

850642G

Policy instance

Insurance contract or identification number	850642G
Number of Individuals Covered	250
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $11,188
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

402698

Policy instance

Insurance contract or identification number	402698
Number of Individuals Covered	92
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $15,774
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

055-3045-01

Policy instance

Insurance contract or identification number	055-3045-01
Number of Individuals Covered	41
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $234
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

SEE ATTACHED

Policy instance

Insurance contract or identification number	SEE ATTACHED
Number of Individuals Covered	99
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $8,621
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

067416

Policy instance

Insurance contract or identification number	067416
Number of Individuals Covered	7
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $639
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

64594

Policy instance

Insurance contract or identification number	64594
Number of Individuals Covered	92
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $7,568
Total amount of fees paid to insurance company	USD $58,084
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:	LYNCH MANAGEMENT GROUP
Employer identification number (EIN):	592607387
NAIC Classification:	441110
NAIC Description:	New Car Dealers