401k Plan data: WHM LLC LXR EMPLOYEE BENEFIT PLAN plan

WHM LLC LXR EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	WHM LLC LXR EMPLOYEE BENEFIT PLAN
Plan identification number	501

WHM LLC LXR EMPLOYEE BENEFIT 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) Prepaid legal Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

WHM LLC LXR EMPLOYEE BENEFIT PLAN has sponsored the creation of one or more 401k plans.

Company Name: WHM LLC LXR EMPLOYEE BENEFIT PLAN

Employer identification number (EIN): 650676005

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WHM LLC LXR EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2018-01-01
501 2017-01-01 FARAH EASTON
501 2016-01-01 FARAH EASTON
501 2015-01-01 FARAH EASTON
501 2014-01-01 FARAH EASTON
501 2014-01-01 FARAH EASTON
501 2013-01-01 FARAH EASTON
501 2012-01-01 FARAH EASTON
501 2011-01-01 SONIA MARRERO
501 2010-01-01 SONIA MARRERO
501 2009-01-01 SONIA MARRERO

Plan Statistics for WHM LLC LXR EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for WHM LLC LXR EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Total participants 2019-01-01 0
2018: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Total participants 2018-01-01 0
2017: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Total participants 2017-01-01 0
2016: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Total participants 2016-01-01 0
2015: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Total participants 2015-01-01 0
2014: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Total participants 2014-01-01 0
2013: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7,171
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
2012: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7,345
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 7,045
Number of retired or separated participants receiving benefits 2012-01-01 126
Total of all active and inactive participants 2012-01-01 7,171
Total participants 2012-01-01 7,171
2011: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 7,602
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 7,250
Number of retired or separated participants receiving benefits 2011-01-01 95
Total of all active and inactive participants 2011-01-01 7,345
Total participants 2011-01-01 7,345
2010: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 6,747
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7,477
Number of retired or separated participants receiving benefits 2010-01-01 125
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 7,602
Total participants 2010-01-01 7,602
2009: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8,828
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6,519
Number of retired or separated participants receiving benefits 2009-01-01 228
Total of all active and inactive participants 2009-01-01 6,747
Total participants 2009-01-01 6,747

Measure	Date	Value
2019: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Total participants	2019-01-01	0
2018: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Total participants	2018-01-01	0
2017: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Total participants	2017-01-01	0
2016: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Total participants	2016-01-01	0
2015: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Total participants	2015-01-01	0
2014: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Total participants	2014-01-01	0
2013: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7,171
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
2012: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7,345
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	7,045
Number of retired or separated participants receiving benefits	2012-01-01	126
Total of all active and inactive participants	2012-01-01	7,171
Total participants	2012-01-01	7,171
2011: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	7,602
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	7,250
Number of retired or separated participants receiving benefits	2011-01-01	95
Total of all active and inactive participants	2011-01-01	7,345
Total participants	2011-01-01	7,345
2010: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	6,747
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7,477
Number of retired or separated participants receiving benefits	2010-01-01	125
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	7,602
Total participants	2010-01-01	7,602
2009: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8,828
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6,519
Number of retired or separated participants receiving benefits	2009-01-01	228
Total of all active and inactive participants	2009-01-01	6,747
Total participants	2009-01-01	6,747

Form 5500 Responses for WHM LLC LXR EMPLOYEE BENEFIT PLAN

2019: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: WHM LLC LXR EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	147
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $37,054
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $741,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,054

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	146
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-03
Total amount of commissions paid to insurance broker	USD $843
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $843

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	147
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $37,054
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $741,089
Commission paid to Insurance Broker	USD $37,054

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	146
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $389
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,725
Commission paid to Insurance Broker	USD $389

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	160
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,385

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300462

Policy instance

Insurance contract or identification number	VPL 300462
Number of Individuals Covered	171
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,899
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,899
Insurance broker name	ALLIANT INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	826
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,212
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $25,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,212
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 205658

Policy instance

Insurance contract or identification number	VAR 205658
Number of Individuals Covered	327
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,716
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $33,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,716
Insurance broker name	ALLIANT INSURANCE SERVICES INC

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	169
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $3,252
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,252
Insurance broker name	MARSH SALDANA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181723

Policy instance

Insurance contract or identification number	VG 181723
Number of Individuals Covered	374
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,541
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $145,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,541
Insurance broker name	ALLIANT INSURANCE SERVICES INC

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	160
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $41,629
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,412,474
Commission paid to Insurance Broker	USD $41,629
Insurance broker name	MARSH SALDANA

CATALYST HEALTH SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

PBS6227

Policy instance

Insurance contract or identification number	PBS6227
Number of Individuals Covered	782
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $13,783
Total amount of fees paid to insurance company	USD $13,783
Other welfare benefits provided	ASO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,783
Amount paid for insurance broker fees	13783
Insurance broker organization code?	3
Insurance broker name	MARSH SALDANA

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	42
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 152628

Policy instance

Insurance contract or identification number	GL 152628
Number of Individuals Covered	58
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $378
Total amount of fees paid to insurance company	USD $516
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $5,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $378
Amount paid for insurance broker fees	516
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

00106

Policy instance

Insurance contract or identification number	00106
Number of Individuals Covered	117
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,429
Total amount of fees paid to insurance company	USD $1,429
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,429
Amount paid for insurance broker fees	1429
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

76165

Policy instance

Insurance contract or identification number	76165
Number of Individuals Covered	15
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $54
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,566
Commission paid to Insurance Broker	USD $54
Amount paid for insurance broker fees	54
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	53
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $324
Total amount of fees paid to insurance company	USD $324
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $324
Amount paid for insurance broker fees	324
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	759
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $47,036
Total amount of fees paid to insurance company	USD $47,036
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,036
Amount paid for insurance broker fees	47036
Insurance broker organization code?	3
Insurance broker name	MARSH SALDANA

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	752
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $3,957
Total amount of fees paid to insurance company	USD $3,957
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $158,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,957
Amount paid for insurance broker fees	3957
Insurance broker organization code?	3
Insurance broker name	MARSH SALDANA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 205674

Policy instance

Insurance contract or identification number	VAR 205674
Number of Individuals Covered	28
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $348
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $348
Insurance broker name	ALLIANT INSURANCE SERVICES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181723

Policy instance

Insurance contract or identification number	VG 181723
Number of Individuals Covered	464
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,987
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $55,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,987
Insurance broker name	ALLIANT INSURANCE SERVICES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300459

Policy instance

Insurance contract or identification number	VPL 300459
Number of Individuals Covered	31
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $3,292
Other welfare benefits provided	VOLUNTARY LONG TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $16,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,292
Insurance broker name	ALLIANT INSURANCE SERVICES

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

00106

Policy instance

Insurance contract or identification number	00106
Number of Individuals Covered	166
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,431
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,431
Insurance broker name	DDIC BROKER - ALLIANT INSURANCE

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

Policy contract number

0837285

Policy instance

Insurance contract or identification number	0837285
Number of Individuals Covered	215
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $61,764
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,285,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,764
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

76165

Policy instance

Insurance contract or identification number	76165
Number of Individuals Covered	81396
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $38
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38
Insurance broker name	ALLIANT INSURANCE

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	761
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $41,562
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,743,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,562
Insurance broker name	MARSH SALDANA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 205658

Policy instance

Insurance contract or identification number	VAR 205658
Number of Individuals Covered	312
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $16,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 152628

Policy instance

Insurance contract or identification number	GL 152628
Number of Individuals Covered	3
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $727
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $727
Insurance broker name	ALLIANT INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181719

Policy instance

Insurance contract or identification number	VG 181719
Number of Individuals Covered	53
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,990
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,990
Insurance broker name	ALLIANT INSURANCE SERVICES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125136

Policy instance

Insurance contract or identification number	LTD 125136
Number of Individuals Covered	3
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,001
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,001
Insurance broker name	ALLIANT INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 151077

Policy instance

Insurance contract or identification number	G 151077
Number of Individuals Covered	15
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $308
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $3,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $308
Insurance broker name	ALLIANT INSURANCE SERVICES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	853
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,877
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,877
Insurance broker name	ALLIANT INSURANCE SERVICES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300462

Policy instance

Insurance contract or identification number	VPL 300462
Number of Individuals Covered	121
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,895
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LONG TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $22,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,895
Insurance broker name	ALLIANT INSURANCE SERVICES

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	53
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $600
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $600
Insurance broker name	ALLIANT INSURANCE SERVICES INC

CATALYST HEALTH SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

PBS 6227

Policy instance

Insurance contract or identification number	PBS 6227
Number of Individuals Covered	791
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $13,783
Welfare Benefit Premiums Paid to Carrier	USD $950,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,783
Insurance broker name	MARSH SALDANA

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	756
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,005
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,005
Insurance broker name	MARSH SALDANA

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	76
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 151077

Policy instance

Insurance contract or identification number	GL 151077
Number of Individuals Covered	16
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $564
Other welfare benefits provided	GROUP LIF AND ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $564
Insurance broker name	CHRISTIAN LAPEYRE INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 151077

Policy instance

Insurance contract or identification number	G 151077
Number of Individuals Covered	42
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $4,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 205658

Policy instance

Insurance contract or identification number	VAR 205658
Number of Individuals Covered	310
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	0 ACIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $19,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	760
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $4,104
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,104
Insurance broker name	MARSHA SALDAA

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	77
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181723

Policy instance

Insurance contract or identification number	VG 181723
Number of Individuals Covered	467
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $67,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004017

Policy instance

Insurance contract or identification number	SP0004017
Number of Individuals Covered	851
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $54,967
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,943,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,967
Insurance broker name	MARSH SALDAA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181719

Policy instance

Insurance contract or identification number	VG 181719
Number of Individuals Covered	1153
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $95,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300459

Policy instance

Insurance contract or identification number	VPL 300459
Number of Individuals Covered	337
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	VOLUNTARY LONG TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $55,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	846
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300462

Policy instance

Insurance contract or identification number	VPL 300462
Number of Individuals Covered	87
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	109
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CATALYST HEALTH SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

6227

Policy instance

Insurance contract or identification number	6227
Number of Individuals Covered	782
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $10,352
Welfare Benefit Premiums Paid to Carrier	USD $896,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,352
Insurance broker name	MARSH SALDAA

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	110
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $574
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $574
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

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

Policy contract number

818983

Policy instance

Insurance contract or identification number	818983
Number of Individuals Covered	1985
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,886,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300459

Policy instance

Insurance contract or identification number	VPL 300459
Number of Individuals Covered	402
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $7,061
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,061
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 204639

Policy instance

Insurance contract or identification number	VAR 204639
Number of Individuals Covered	590
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,682
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $24,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,682
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

CATALYST HEALTH SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

6227

Policy instance

Insurance contract or identification number	6227
Number of Individuals Covered	839
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $14,703
Welfare Benefit Premiums Paid to Carrier	USD $600,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,703
Insurance broker name	MARSH SALDANA

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-00106

Policy instance

Insurance contract or identification number	FL-00106
Number of Individuals Covered	1814
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $343,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

1250010

Policy instance

Insurance contract or identification number	1250010
Number of Individuals Covered	110
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,301
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $13,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,301
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	908
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $924
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $13,201
Commission paid to Insurance Broker	USD $924
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 1510177

Policy instance

Insurance contract or identification number	G 1510177
Number of Individuals Covered	27
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $245
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $3,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $245
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	839
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,783
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,783
Insurance broker name	MARSH SALDANA

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	1612
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181719

Policy instance

Insurance contract or identification number	VG 181719
Number of Individuals Covered	1395
Insurance policy start date	2013-01-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $12,484
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $175,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,484
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	908
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $924
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $13,201

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	839
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,783
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	1612
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Welfare Benefit Premiums Paid to Carrier	USD $59,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181719

Policy instance

Insurance contract or identification number	VG 181719
Number of Individuals Covered	1404
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $12,484
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $178,344

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

1250010

Policy instance

Insurance contract or identification number	1250010
Number of Individuals Covered	110
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of fees paid to insurance company	USD $1,119
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $13,324

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-00106

Policy instance

Insurance contract or identification number	FL-00106
Number of Individuals Covered	1814
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $343,223

CATALYST HEALTH SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

6227

Policy instance

Insurance contract or identification number	6227
Number of Individuals Covered	839
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $14,703
Welfare Benefit Premiums Paid to Carrier	USD $600,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300459

Policy instance

Insurance contract or identification number	VPL 300459
Number of Individuals Covered	402
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $7,061
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,867

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

Policy contract number

818983

Policy instance

Insurance contract or identification number	818983
Number of Individuals Covered	1985
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,886,763

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	110
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $573
Temporary Disability Insurance Welfare Benefit	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 1510177

Policy instance

Insurance contract or identification number	G 1510177
Number of Individuals Covered	27
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $245
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $3,501

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 204639

Policy instance

Insurance contract or identification number	VAR 204639
Number of Individuals Covered	592
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,682
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $24,035

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0705

Policy instance

Insurance contract or identification number	0705
Number of Individuals Covered	830
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,704
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $188,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,704
Insurance broker organization code?	3
Insurance broker name	MARSHA SALDANA

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6NQCD5000

Policy instance

Insurance contract or identification number	6NQCD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $89
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56
Insurance broker organization code?	3
Insurance broker name	GORDON GLADSTONE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300462

Policy instance

Insurance contract or identification number	VPL 300462
Number of Individuals Covered	29
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $809
Total amount of fees paid to insurance company	USD $136
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $809
Amount paid for insurance broker fees	136
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181723

Policy instance

Insurance contract or identification number	VG 181723
Number of Individuals Covered	481
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,062
Total amount of fees paid to insurance company	USD $751
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $58,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,062
Amount paid for insurance broker fees	751
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6NMCD5000

Policy instance

Insurance contract or identification number	6NMCD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $282
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $176
Insurance broker organization code?	3
Insurance broker name	GORDON GLADSTONE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 204640

Policy instance

Insurance contract or identification number	VAR 204640
Number of Individuals Covered	227
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,529
Total amount of fees paid to insurance company	USD $296
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,529
Amount paid for insurance broker fees	296
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVIES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 1510177

Policy instance

Insurance contract or identification number	G 1510177
Number of Individuals Covered	19
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $614
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $8,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $614
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6NMCD5000

Policy instance

Insurance contract or identification number	6NMCD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $282
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $176
Insurance broker organization code?	3
Insurance broker name	GORDON GLADSTONE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 181719

Policy instance

Insurance contract or identification number	VG 181719
Number of Individuals Covered	1385
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $19,477
Total amount of fees paid to insurance company	USD $3,442
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $278,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,477
Amount paid for insurance broker fees	3442
Insurance broker organization code?	3
Insurance broker name	ALIANT INSURANCE SERVICES INC

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

1-09999-300

Policy instance

Insurance contract or identification number	1-09999-300
Number of Individuals Covered	829
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $41,561
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,561
Insurance broker organization code?	3
Insurance broker name	MARSHA SALDANA

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

1250010

Policy instance

Insurance contract or identification number	1250010
Number of Individuals Covered	119
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,141
Total amount of fees paid to insurance company	USD $436
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $21,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,141
Amount paid for insurance broker fees	436
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 204639

Policy instance

Insurance contract or identification number	VAR 204639
Number of Individuals Covered	632
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,209
Total amount of fees paid to insurance company	USD $600
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,209
Amount paid for insurance broker fees	600
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

12288744

Policy instance

Insurance contract or identification number	12288744
Number of Individuals Covered	1542
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251268

Policy instance

Insurance contract or identification number	DBL 251268
Number of Individuals Covered	120
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,264
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,264
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 145893

Policy instance

Insurance contract or identification number	GL 145893
Number of Individuals Covered	877
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,166
Total amount of fees paid to insurance company	USD $275
Other welfare benefits provided	GROUP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $30,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,166
Amount paid for insurance broker fees	275
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

FL-00106

Policy instance

Insurance contract or identification number	FL-00106
Number of Individuals Covered	1093
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6NACD5000

Policy instance

Insurance contract or identification number	6NACD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $30
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30
Insurance broker organization code?	3
Insurance broker name	EBC INC

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6NQCD5000

Policy instance

Insurance contract or identification number	6NQCD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $88
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DISABILITY BENEFIT LAW
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55
Insurance broker organization code?	3
Insurance broker name	GORDON GLADSTONE

EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )

Policy contract number

6JVCD5000

Policy instance

Insurance contract or identification number	6JVCD5000
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $38
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24
Insurance broker organization code?	3
Insurance broker name	GORDON GLADSTONE

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

06165

Policy instance

Insurance contract or identification number	06165
Number of Individuals Covered	487
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

129986

Policy instance

Insurance contract or identification number	129986
Number of Individuals Covered	140
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $20,227
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $415,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,227
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO (National Association of Insurance Commissioners NAIC id number: 79715 )

Policy contract number

V0005

Policy instance

Insurance contract or identification number	V0005
Number of Individuals Covered	857
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $108
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108
Insurance broker organization code?	3
Insurance broker name	MARSHA SALDANA

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

33740

Policy instance

Insurance contract or identification number	33740
Number of Individuals Covered	153
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,454
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $454
Insurance broker organization code?	3
Insurance broker name	MICHAEL D. PERNA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 300459

Policy instance

Insurance contract or identification number	VPL 300459
Number of Individuals Covered	312
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,840
Total amount of fees paid to insurance company	USD $1,737
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $154,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,840
Amount paid for insurance broker fees	1737
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC

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Company Name:	WHM LLC LXR EMPLOYEE BENEFIT PLAN
Employer identification number (EIN):	650676005
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels