401k Plan data: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN plan

THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 401k Plan overview

Plan Name	THE LEXINGTON SCHOOL BENEFITS WRAP PLAN
Plan identification number	501

THE LEXINGTON SCHOOL BENEFITS WRAP 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 Other welfare benefit cover

401k Sponsoring company profile

THE LEXINGTON SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: THE LEXINGTON SCHOOL

Employer identification number (EIN): 610563291

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE LEXINGTON SCHOOL BENEFITS WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 SUSAN O'BRIEN 2023-11-13
501 2021-06-01 SUSAN O'BRIEN 2022-11-21
501 2020-06-01 SUSAN O'BRIEN 2021-10-27
501 2019-06-01 SUSAN O'BRIEN 2020-11-01
501 2018-06-01 SUSAN O'BRIEN 2019-11-01
501 2017-06-01
501 2016-06-01
501 2015-06-01
501 2014-06-01
501 2013-06-01
501 2012-09-01 ROBERT THOMPSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-06-01	SUSAN O'BRIEN	2023-11-13
501	2021-06-01	SUSAN O'BRIEN	2022-11-21
501	2020-06-01	SUSAN O'BRIEN	2021-10-27
501	2019-06-01	SUSAN O'BRIEN	2020-11-01
501	2018-06-01	SUSAN O'BRIEN	2019-11-01
501	2017-06-01
501	2016-06-01
501	2015-06-01
501	2014-06-01
501	2013-06-01
501	2012-09-01	ROBERT THOMPSON

Plan Statistics for THE LEXINGTON SCHOOL BENEFITS WRAP PLAN

401k plan membership statisitcs for THE LEXINGTON SCHOOL BENEFITS WRAP PLAN

Measure Date Value
2022: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 125
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 125
Total of all active and inactive participants 2022-06-01 125
2021: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-06-01 123
Total number of active participants reported on line 7a of the Form 5500 2021-06-01 125
Total of all active and inactive participants 2021-06-01 125
2020: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 118
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 123
Total of all active and inactive participants 2020-06-01 123
2019: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year 2019-06-01 120
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 118
Total of all active and inactive participants 2019-06-01 118
2018: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 117
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 120
Total of all active and inactive participants 2018-06-01 120
2017: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 115
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 117
Total of all active and inactive participants 2017-06-01 117
2016: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 111
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 115
Total of all active and inactive participants 2016-06-01 115
2015: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 110
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 111
Total of all active and inactive participants 2015-06-01 111
2014: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 109
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 110
Total of all active and inactive participants 2014-06-01 110
2013: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 108
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 109
Total of all active and inactive participants 2013-06-01 109
2012: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 103
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 108
Total of all active and inactive participants 2012-09-01 108

Measure	Date	Value
2022: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	125
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	125
Total of all active and inactive participants	2022-06-01	125
2021: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	123
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	125
Total of all active and inactive participants	2021-06-01	125
2020: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	118
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	123
Total of all active and inactive participants	2020-06-01	123
2019: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	120
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	118
Total of all active and inactive participants	2019-06-01	118
2018: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	117
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	120
Total of all active and inactive participants	2018-06-01	120
2017: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	115
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	117
Total of all active and inactive participants	2017-06-01	117
2016: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	111
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	115
Total of all active and inactive participants	2016-06-01	115
2015: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	110
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	111
Total of all active and inactive participants	2015-06-01	111
2014: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	109
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	110
Total of all active and inactive participants	2014-06-01	110
2013: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	108
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	109
Total of all active and inactive participants	2013-06-01	109
2012: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	103
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	108
Total of all active and inactive participants	2012-09-01	108

Form 5500 Responses for THE LEXINGTON SCHOOL BENEFITS WRAP PLAN

2022: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2021: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2020: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2019: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2017: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2016: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2015: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	First time form 5500 has been submitted	Yes
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	Yes
2013-06-01	This submission is the final filing	Yes
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: THE LEXINGTON SCHOOL BENEFITS WRAP PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	First time form 5500 has been submitted	Yes
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	125
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $2,473
Total amount of fees paid to insurance company	USD $1,459
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,473
Insurance broker organization code?	3
Amount paid for insurance broker fees	1459
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	70
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $3,724
Total amount of fees paid to insurance company	USD $1,241
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $24,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,724
Insurance broker organization code?	3
Amount paid for insurance broker fees	1241
Additional information about fees paid to insurance broker	ENROLLMENT

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	220
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $2,520
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,520
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

L02949

Policy instance

Insurance contract or identification number	L02949
Number of Individuals Covered	192
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $29,880
Total amount of fees paid to insurance company	USD $4,345
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,063,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,880
Amount paid for insurance broker fees	4345
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	125
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $1,651
Total amount of fees paid to insurance company	USD $777
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,651
Insurance broker organization code?	3
Amount paid for insurance broker fees	777
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

00034000

Policy instance

Insurance contract or identification number	00034000
Number of Individuals Covered	42
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $12,600
Total amount of fees paid to insurance company	USD $451
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,635
Insurance broker organization code?	3
Amount paid for insurance broker fees	451
Additional information about fees paid to insurance broker	FEES

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	125
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $3,573
Total amount of fees paid to insurance company	USD $1,545
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,573
Insurance broker organization code?	3
Amount paid for insurance broker fees	1545
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	125
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $3,304
Total amount of fees paid to insurance company	USD $1,187
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,304
Insurance broker organization code?	3
Amount paid for insurance broker fees	886
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	125
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $2,312
Total amount of fees paid to insurance company	USD $1,132
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,312
Insurance broker organization code?	3
Amount paid for insurance broker fees	844
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	125
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $1,513
Total amount of fees paid to insurance company	USD $595
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,513
Insurance broker organization code?	3
Amount paid for insurance broker fees	443
Additional information about fees paid to insurance broker	ENROLLMENT

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

L02949

Policy instance

Insurance contract or identification number	L02949
Number of Individuals Covered	200
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $26,971
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,166,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,971
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	227
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $2,715
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,715
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	69
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $2,991
Total amount of fees paid to insurance company	USD $776
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,991
Insurance broker organization code?	3
Amount paid for insurance broker fees	581
Additional information about fees paid to insurance broker	ENROLLMENT

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

Policy contract number

00405003340

Policy instance

Insurance contract or identification number	00405003340
Number of Individuals Covered	19
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $566
Total amount of fees paid to insurance company	USD $94
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $566
Insurance broker organization code?	3
Amount paid for insurance broker fees	94
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	123
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $3,705
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,218
Insurance broker organization code?	3

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	123
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $1,677
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,474
Insurance broker organization code?	3

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	123
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,544
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,249
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W32165

Policy instance

Insurance contract or identification number	W32165
Number of Individuals Covered	185
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $26,507
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $990,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,507
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	221
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,225
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,225
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	64
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,686
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,461
Insurance broker organization code?	3

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

Policy contract number

00405003340

Policy instance

Insurance contract or identification number	00405003340
Number of Individuals Covered	25
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $643
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $643
Insurance broker organization code?	3

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	118
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $3,207
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,207
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	224
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $3,194
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,194
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00210563

Policy instance

Insurance contract or identification number	00210563
Number of Individuals Covered	183
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $28,754
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,039,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,754
Insurance broker organization code?	3

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	118
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $1,474
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,474
Insurance broker organization code?	3

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	118
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $2,257
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $25,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,257
Insurance broker organization code?	3

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	120
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,381
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $27,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,381
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	220
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,720
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,720
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00210563

Policy instance

Insurance contract or identification number	00210563
Number of Individuals Covered	193
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $26,798
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,024,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,798
Insurance broker organization code?	3

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	120
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,544
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,544
Insurance broker organization code?	3

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	120
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $3,485
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,485
Insurance broker organization code?	3

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	117
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $3,390
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,390
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	117
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,330
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,330
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	117
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $1,491
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,491
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00210563

Policy instance

Insurance contract or identification number	00210563
Number of Individuals Covered	179
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $28,781
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $931,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,781
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	211
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,936
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,936
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	111
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $3,268
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,268
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	111
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $2,294
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $24,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,294
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	111
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $1,433
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,433
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00210563

Policy instance

Insurance contract or identification number	00210563
Number of Individuals Covered	141
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $26,979
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $748,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,979
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	187
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $2,671
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,671
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	110
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $1,804
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
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,804
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	110
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $2,867
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,867
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	110
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $1,353
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,353
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00210563

Policy instance

Insurance contract or identification number	00210563
Number of Individuals Covered	155
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $26,240
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
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $668,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,240
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0948860

Policy instance

Insurance contract or identification number	0948860
Number of Individuals Covered	176
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $2,714
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,714
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	109
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $1,322
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,322
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163599

Policy instance

Insurance contract or identification number	000010163599
Number of Individuals Covered	109
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $1,725
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
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,725
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163600

Policy instance

Insurance contract or identification number	000010163600
Number of Individuals Covered	109
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $2,770
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,770
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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

Policy contract number

000010163601

Policy instance

Insurance contract or identification number	000010163601
Number of Individuals Covered	108
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $4,453
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
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,453
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT ASSOCIATES, INC.

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Company Name:	THE LEXINGTON SCHOOL
Employer identification number (EIN):	610563291
NAIC Classification:	611000