401k Plan data: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN plan

RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN
Plan identification number	501

RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. has sponsored the creation of one or more 401k plans.

Company Name: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A.

Employer identification number (EIN): 710335138

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 R. KEVIN NORTON 2023-10-13 R. KEVIN NORTON 2023-10-13
501 2021-01-01 R. KEVIN NORTON, CPA 2022-10-17 R. KEVIN NORTON, CPA 2022-10-17
501 2020-01-01 R. KEVIN NORTON, CPA 2021-08-02 R. KEVIN NORTON, CPA 2021-08-02
501 2019-01-01 R. KEVIN NORTON, CPA 2020-09-01 R. KEVIN NORTON, CPA 2020-09-01
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01 THOMAS G. MAY, CPA
501 2014-01-01 DAVID HUMPHREY DAVID HUMPHREY
501 2013-01-01
501 2012-01-01 DAVID HUMPHREY
501 2011-01-01 DAVID HUMPHREY
501 2010-01-01 DAVID HUMPHREY
501 2009-01-01 DAVID HUMPHREY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	R. KEVIN NORTON	2023-10-13	R. KEVIN NORTON	2023-10-13
501	2021-01-01	R. KEVIN NORTON, CPA	2022-10-17	R. KEVIN NORTON, CPA	2022-10-17
501	2020-01-01	R. KEVIN NORTON, CPA	2021-08-02	R. KEVIN NORTON, CPA	2021-08-02
501	2019-01-01	R. KEVIN NORTON, CPA	2020-09-01	R. KEVIN NORTON, CPA	2020-09-01
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01	THOMAS G. MAY, CPA
501	2014-01-01	DAVID HUMPHREY		DAVID HUMPHREY
501	2013-01-01
501	2012-01-01	DAVID HUMPHREY
501	2011-01-01	DAVID HUMPHREY
501	2010-01-01	DAVID HUMPHREY
501	2009-01-01	DAVID HUMPHREY

Plan Statistics for RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 116
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 116
2021: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 112
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 112
2020: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 115
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 115
2019: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 123
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 123
2018: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 130
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 130
2017: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 119
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 119
2016: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 127
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 127
2015: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 129
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 129
2014: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 127
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 127
2013: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 120
Total of all active and inactive participants 2013-01-01 120
2012: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 116
Total of all active and inactive participants 2012-01-01 116
2011: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 115
Total of all active and inactive participants 2011-01-01 115
2010: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 114
Total of all active and inactive participants 2010-01-01 114
2009: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 108
Total of all active and inactive participants 2009-01-01 108

Measure	Date	Value
2022: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	116
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	116
2021: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	112
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	112
2020: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	115
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	115
2019: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	123
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	123
2018: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	130
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	130
2017: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	119
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	119
2016: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	127
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	127
2015: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	129
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	129
2014: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	127
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	127
2013: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	120
Total of all active and inactive participants	2013-01-01	120
2012: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	116
Total of all active and inactive participants	2012-01-01	116
2011: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	115
Total of all active and inactive participants	2011-01-01	115
2010: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	114
Total of all active and inactive participants	2010-01-01	114
2009: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	108
Total of all active and inactive participants	2009-01-01	108

Form 5500 Responses for RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN

2022: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2017: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2016: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2015: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2014: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2013: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS 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: RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A. EMPLOYEE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
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

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00000578V

Policy instance

Insurance contract or identification number	00000578V
Number of Individuals Covered	124
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,147
Vision 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 $3,147
Insurance broker organization code?	3

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

Policy contract number

10240861

Policy instance

Insurance contract or identification number	10240861
Number of Individuals Covered	30
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $4,771
Total amount of fees paid to insurance company	USD $954
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $19,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,771
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	954

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

Policy contract number

10252271

Policy instance

Insurance contract or identification number	10252271
Number of Individuals Covered	105
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $24,358
Total amount of fees paid to insurance company	USD $4,872
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,358
Insurance broker organization code?	3
Amount paid for insurance broker fees	4872
Additional information about fees paid to insurance broker	BENTECH

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

Policy contract number

10252270

Policy instance

Insurance contract or identification number	10252270
Number of Individuals Covered	105
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $5,871
Total amount of fees paid to insurance company	USD $1,174
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,871
Insurance broker organization code?	3
Amount paid for insurance broker fees	1174
Additional information about fees paid to insurance broker	BENTECH

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002414900

Policy instance

Insurance contract or identification number	417002414900
Number of Individuals Covered	119
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	301
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,248
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 $11,248
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	295
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,045
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 $11,045
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002414900

Policy instance

Insurance contract or identification number	417002414900
Number of Individuals Covered	119
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10252270

Policy instance

Insurance contract or identification number	10252270
Number of Individuals Covered	111
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $6,695
Total amount of fees paid to insurance company	USD $1,339
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $26,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,695
Insurance broker organization code?	3
Amount paid for insurance broker fees	1339
Additional information about fees paid to insurance broker	BENTECH

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

Policy contract number

10252271

Policy instance

Insurance contract or identification number	10252271
Number of Individuals Covered	105
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $27,621
Total amount of fees paid to insurance company	USD $5,524
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,621
Insurance broker organization code?	3
Amount paid for insurance broker fees	5524
Additional information about fees paid to insurance broker	BENTECH

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

Policy contract number

10240861

Policy instance

Insurance contract or identification number	10240861
Number of Individuals Covered	21
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $3,487
Total amount of fees paid to insurance company	USD $265
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $13,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,487
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Amount paid for insurance broker fees	265

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00000578V

Policy instance

Insurance contract or identification number	00000578V
Number of Individuals Covered	120
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,886
Vision 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 $2,886
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	036959
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $204
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $19,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $204
Insurance broker organization code?	3

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

Policy contract number

768028G

Policy instance

Insurance contract or identification number	768028G
Number of Individuals Covered	123
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of fees paid to insurance company	USD $945
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	945
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

Policy instance

Number of Individuals Covered	119
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $275,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10252270

Policy instance

Insurance contract or identification number	10252270
Number of Individuals Covered	117
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $7,439
Total amount of fees paid to insurance company	USD $1,488
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $29,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,439
Insurance broker organization code?	3
Amount paid for insurance broker fees	1488
Additional information about fees paid to insurance broker	BENTECH

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

Policy contract number

10252271

Policy instance

Insurance contract or identification number	10252271
Number of Individuals Covered	117
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $30,659
Total amount of fees paid to insurance company	USD $6,132
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,659
Insurance broker organization code?	3
Amount paid for insurance broker fees	6132
Additional information about fees paid to insurance broker	BENTECH

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

Policy contract number

10240861

Policy instance

Insurance contract or identification number	10240861
Number of Individuals Covered	23
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $3,660
Total amount of fees paid to insurance company	USD $361
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $14,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,660
Amount paid for insurance broker fees	361
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00000578V

Policy instance

Insurance contract or identification number	00000578V
Number of Individuals Covered	113
Insurance policy start date	2020-03-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,642
Vision 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 $1,642
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	316
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,259
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 $13,259
Insurance broker organization code?	3
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $22,575

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

Policy contract number

00520219

Policy instance

Insurance contract or identification number	00520219
Number of Individuals Covered	121
Insurance policy start date	2019-01-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $1,299
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $5,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,299
Additional information about fees paid to insurance broker	MISCELLANEOUS
Insurance broker organization code?	3

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

Policy contract number

768028G

Policy instance

Insurance contract or identification number	768028G
Number of Individuals Covered	123
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of fees paid to insurance company	USD $945
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	945
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

10252270

Policy instance

Insurance contract or identification number	10252270
Number of Individuals Covered	117
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $7,439
Total amount of fees paid to insurance company	USD $1,488
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,439
Insurance broker organization code?	3
Amount paid for insurance broker fees	1488

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL33140

Policy instance

Insurance contract or identification number	HCL33140
Number of Individuals Covered	122
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $275,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10252271

Policy instance

Insurance contract or identification number	10252271
Number of Individuals Covered	117
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $30,659
Total amount of fees paid to insurance company	USD $6,132
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,659
Insurance broker organization code?	3
Amount paid for insurance broker fees	6132

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

Policy contract number

10240861

Policy instance

Insurance contract or identification number	10240861
Number of Individuals Covered	23
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $3,360
Total amount of fees paid to insurance company	USD $361
Unemployment Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,360
Amount paid for insurance broker fees	361
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL33140

Policy instance

Insurance contract or identification number	HCL33140
Number of Individuals Covered	117
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $2,495
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $218,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,495
Insurance broker organization code?	3

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

Policy contract number

768028G

Policy instance

Insurance contract or identification number	768028G
Number of Individuals Covered	120
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $5,658
Total amount of fees paid to insurance company	USD $2,256
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $113,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,658
Insurance broker organization code?	3
Amount paid for insurance broker fees	2256
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

00520219

Policy instance

Insurance contract or identification number	00520219
Number of Individuals Covered	123
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $7,312
Total amount of fees paid to insurance company	USD $1,699
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $29,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,312
Amount paid for insurance broker fees	1699
Additional information about fees paid to insurance broker	MISCELLANEOUS
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	325
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,737
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 $11,737
Insurance broker organization code?	3
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $46,270

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

Policy contract number

768028G

Policy instance

Insurance contract or identification number	768028G
Number of Individuals Covered	116
Insurance policy start date	2017-01-01
Insurance policy end date	2017-02-28
Total amount of commissions paid to insurance broker	USD $938
Total amount of fees paid to insurance company	USD $2,263
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2263
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $938
Insurance broker name

GREAT MIDWEST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18694 )

Policy contract number

2016 10171-8

Policy instance

Insurance contract or identification number	2016 10171-8
Number of Individuals Covered	110
Insurance policy start date	2016-03-01
Insurance policy end date	2017-02-28
Total amount of fees paid to insurance company	USD $108,579
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	60636
Additional information about fees paid to insurance broker	CLAIMS PROCESSING, PLAN ADMINISTRA- TION, OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	AETNA - PPO

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

Policy contract number

00520219

Policy instance

Insurance contract or identification number	00520219
Number of Individuals Covered	119
Insurance policy start date	2016-03-01
Insurance policy end date	2017-02-28
Total amount of commissions paid to insurance broker	USD $7,200
Total amount of fees paid to insurance company	USD $277
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $28,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,200
Amount paid for insurance broker fees	277
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	341
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,935
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 $11,935
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	334
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,925
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 $2,632
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	121
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $2,389
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $29,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,176
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

GL0080

Policy instance

Insurance contract or identification number	GL0080
Number of Individuals Covered	113
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of fees paid to insurance company	USD $96,716
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	22847
Additional information about fees paid to insurance broker	CONSULTING
Insurance broker organization code?	3
Insurance broker name	AETNA - PPO

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

Policy contract number

768028G

Policy instance

Insurance contract or identification number	768028G
Number of Individuals Covered	124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,260
Total amount of fees paid to insurance company	USD $4,811
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,260
Amount paid for insurance broker fees	4811
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	122
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,175
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $27,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,175
Insurance broker organization code?	3
Insurance broker name	MICHAEL L BAXLEY

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

GL0080

Policy instance

Insurance contract or identification number	GL0080
Number of Individuals Covered	113
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $28,241
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,138
Insurance broker organization code?	3
Insurance broker name	CORESOURCE, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	120
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,320
Total amount of fees paid to insurance company	USD $360
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,320
Insurance broker organization code?	3
Amount paid for insurance broker fees	360
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE
Insurance broker name	MEDICAL GROUP INSURANCE SVCS, INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	325
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,589
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 $7,589
Insurance broker organization code?	3
Insurance broker name	MICHAEL LEE BAXLEY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	113
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,315
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 $6,315
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

GL0080

Policy instance

Insurance contract or identification number	GL0080
Number of Individuals Covered	113
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $28,241
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
Welfare Benefit Premiums Paid to Carrier	USD $133,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,138
Insurance broker organization code?	3
Insurance broker name	CORESOURCE, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	102
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,466
Total amount of fees paid to insurance company	USD $360
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 $93,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,466
Insurance broker organization code?	3
Amount paid for insurance broker fees	360
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE
Insurance broker name	MEDICAL GROUP INSURANCE SVCS, INC.

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	98
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $2,056
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	ACCIDENTAL DEATH AND DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $25,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,056
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	104
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,328
Total amount of fees paid to insurance company	USD $360
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 $91,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,328
Insurance broker organization code?	3
Amount paid for insurance broker fees	360
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE
Insurance broker name	MEDICAL GROUP INSURANCE SVCS, INC.

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-201524

Policy instance

Insurance contract or identification number	UNI-201524
Number of Individuals Covered	98
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $32,622
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
Welfare Benefit Premiums Paid to Carrier	USD $140,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,033
Insurance broker organization code?	3
Insurance broker name	CORESOURCE, INC.

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	102
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,991
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	ACCIDENTAL DEATH AND DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $24,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,991
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	111
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,286
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,286
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	108
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,406
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 $92,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	97
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $1,706
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	ACCIDENTAL DEATH AND DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $21,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL20594

Policy instance

Insurance contract or identification number	HCL20594
Number of Individuals Covered	95
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-28
Total amount of commissions paid to insurance broker	USD $30,586
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
Welfare Benefit Premiums Paid to Carrier	USD $133,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	100
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,491
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000000578

Policy instance

Insurance contract or identification number	000000578
Number of Individuals Covered	112
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,900
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,900
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

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

Policy contract number

000010031381

Policy instance

Insurance contract or identification number	000010031381
Number of Individuals Covered	106
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $1,753
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	ACCIDENTAL DEATH AND DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $21,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,753
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL20594

Policy instance

Insurance contract or identification number	HCL20594
Number of Individuals Covered	95
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $30,927
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
Welfare Benefit Premiums Paid to Carrier	USD $136,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,114
Insurance broker organization code?	3
Insurance broker name	CORESOURCE, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	108
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,641
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 $95,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,641
Insurance broker organization code?	3
Insurance broker name	MICHAEL L. BAXLEY

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Company Name:	RADIOLOGY CONSULTANTS OF LITTLE ROCK, P.A.
Employer identification number (EIN):	710335138
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)