401k Plan data: SENIOR STAR MGMT CO plan

SENIOR STAR MGMT CO 401k Plan overview

Plan Name	SENIOR STAR MGMT CO
Plan identification number	502

SENIOR STAR MGMT CO Benefits

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

401k Sponsoring company profile

SENIOR STAR MANAGEMENT COMPANY has sponsored the creation of one or more 401k plans.

Company Name: SENIOR STAR MANAGEMENT COMPANY

Employer identification number (EIN): 731220378

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SENIOR STAR MGMT CO

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 KATY KELSAY 2023-06-07
502 2021-01-01 KATY KELSAY 2022-07-06
502 2020-01-01 KATY KELSAY 2021-09-13
502 2019-01-01 KATY KELSAY 2020-05-04
502 2018-01-01 MICKIE HART 2019-08-15
502 2017-01-01 MATTHEW CLIFTON
502 2016-01-01 MATTHEW CLIFTON
502 2015-01-01 MATTHEW CLIFTON
502 2014-01-01 MATTHEW CLIFTON
502 2013-01-01 MATTHEW CLIFTON
502 2012-01-01 MATTHEW CLIFTON
502 2011-01-01 JOHN DORNBLASER
502 2009-01-01 JOHN DORNBLASER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	KATY KELSAY	2023-06-07
502	2021-01-01	KATY KELSAY	2022-07-06
502	2020-01-01	KATY KELSAY	2021-09-13
502	2019-01-01	KATY KELSAY	2020-05-04
502	2018-01-01	MICKIE HART	2019-08-15
502	2017-01-01	MATTHEW CLIFTON
502	2016-01-01	MATTHEW CLIFTON
502	2015-01-01	MATTHEW CLIFTON
502	2014-01-01	MATTHEW CLIFTON
502	2013-01-01	MATTHEW CLIFTON
502	2012-01-01	MATTHEW CLIFTON
502	2011-01-01	JOHN DORNBLASER
502	2009-01-01	JOHN DORNBLASER

Plan Statistics for SENIOR STAR MGMT CO

401k plan membership statisitcs for SENIOR STAR MGMT CO

Measure Date Value
2022: SENIOR STAR MGMT CO 2022 401k membership
Total participants, beginning-of-year 2022-01-01 504
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 504
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 2022-01-01 504
Number of employers contributing to the scheme 2022-01-01 0
2021: SENIOR STAR MGMT CO 2021 401k membership
Total participants, beginning-of-year 2021-01-01 681
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 504
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 2021-01-01 504
Number of employers contributing to the scheme 2021-01-01 0
2020: SENIOR STAR MGMT CO 2020 401k membership
Total participants, beginning-of-year 2020-01-01 643
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 681
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 2020-01-01 681
Number of employers contributing to the scheme 2020-01-01 0
2019: SENIOR STAR MGMT CO 2019 401k membership
Total participants, beginning-of-year 2019-01-01 654
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 643
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 2019-01-01 643
Number of employers contributing to the scheme 2019-01-01 0
2018: SENIOR STAR MGMT CO 2018 401k membership
Total participants, beginning-of-year 2018-01-01 764
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 654
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 2018-01-01 654
Number of employers contributing to the scheme 2018-01-01 0
2017: SENIOR STAR MGMT CO 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,484
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 764
Number of retired or separated participants receiving benefits 2017-01-01 602
Total of all active and inactive participants 2017-01-01 1,366
Total participants 2017-01-01 1,366
2016: SENIOR STAR MGMT CO 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,141
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,264
Number of retired or separated participants receiving benefits 2016-01-01 220
Total of all active and inactive participants 2016-01-01 1,484
Total participants 2016-01-01 1,484
2015: SENIOR STAR MGMT CO 2015 401k membership
Total participants, beginning-of-year 2015-01-01 769
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 921
Number of retired or separated participants receiving benefits 2015-01-01 220
Total of all active and inactive participants 2015-01-01 1,141
Total participants 2015-01-01 0
2014: SENIOR STAR MGMT CO 2014 401k membership
Total participants, beginning-of-year 2014-01-01 716
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 585
Number of retired or separated participants receiving benefits 2014-01-01 184
Total of all active and inactive participants 2014-01-01 769
Total participants 2014-01-01 0
2013: SENIOR STAR MGMT CO 2013 401k membership
Total participants, beginning-of-year 2013-01-01 582
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 531
Number of retired or separated participants receiving benefits 2013-01-01 185
Total of all active and inactive participants 2013-01-01 716
Total participants 2013-01-01 0
2012: SENIOR STAR MGMT CO 2012 401k membership
Total participants, beginning-of-year 2012-01-01 582
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 498
Number of retired or separated participants receiving benefits 2012-01-01 137
Total of all active and inactive participants 2012-01-01 635
Total participants 2012-01-01 0
2011: SENIOR STAR MGMT CO 2011 401k membership
Total participants, beginning-of-year 2011-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 485
Number of retired or separated participants receiving benefits 2011-01-01 97
Total of all active and inactive participants 2011-01-01 582
Total participants 2011-01-01 582
2009: SENIOR STAR MGMT CO 2009 401k membership
Total participants, beginning-of-year 2009-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 176
Number of retired or separated participants receiving benefits 2009-01-01 15
Total of all active and inactive participants 2009-01-01 191
Total participants 2009-01-01 191

Measure	Date	Value
2022: SENIOR STAR MGMT CO 2022 401k membership
Total participants, beginning-of-year	2022-01-01	504
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	504
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	504
Number of employers contributing to the scheme	2022-01-01	0
2021: SENIOR STAR MGMT CO 2021 401k membership
Total participants, beginning-of-year	2021-01-01	681
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	504
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	504
Number of employers contributing to the scheme	2021-01-01	0
2020: SENIOR STAR MGMT CO 2020 401k membership
Total participants, beginning-of-year	2020-01-01	643
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	681
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	681
Number of employers contributing to the scheme	2020-01-01	0
2019: SENIOR STAR MGMT CO 2019 401k membership
Total participants, beginning-of-year	2019-01-01	654
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	643
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	643
Number of employers contributing to the scheme	2019-01-01	0
2018: SENIOR STAR MGMT CO 2018 401k membership
Total participants, beginning-of-year	2018-01-01	764
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	654
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	654
Number of employers contributing to the scheme	2018-01-01	0
2017: SENIOR STAR MGMT CO 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,484
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	764
Number of retired or separated participants receiving benefits	2017-01-01	602
Total of all active and inactive participants	2017-01-01	1,366
Total participants	2017-01-01	1,366
2016: SENIOR STAR MGMT CO 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,141
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,264
Number of retired or separated participants receiving benefits	2016-01-01	220
Total of all active and inactive participants	2016-01-01	1,484
Total participants	2016-01-01	1,484
2015: SENIOR STAR MGMT CO 2015 401k membership
Total participants, beginning-of-year	2015-01-01	769
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	921
Number of retired or separated participants receiving benefits	2015-01-01	220
Total of all active and inactive participants	2015-01-01	1,141
Total participants	2015-01-01	0
2014: SENIOR STAR MGMT CO 2014 401k membership
Total participants, beginning-of-year	2014-01-01	716
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	585
Number of retired or separated participants receiving benefits	2014-01-01	184
Total of all active and inactive participants	2014-01-01	769
Total participants	2014-01-01	0
2013: SENIOR STAR MGMT CO 2013 401k membership
Total participants, beginning-of-year	2013-01-01	582
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	531
Number of retired or separated participants receiving benefits	2013-01-01	185
Total of all active and inactive participants	2013-01-01	716
Total participants	2013-01-01	0
2012: SENIOR STAR MGMT CO 2012 401k membership
Total participants, beginning-of-year	2012-01-01	582
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	498
Number of retired or separated participants receiving benefits	2012-01-01	137
Total of all active and inactive participants	2012-01-01	635
Total participants	2012-01-01	0
2011: SENIOR STAR MGMT CO 2011 401k membership
Total participants, beginning-of-year	2011-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	485
Number of retired or separated participants receiving benefits	2011-01-01	97
Total of all active and inactive participants	2011-01-01	582
Total participants	2011-01-01	582
2009: SENIOR STAR MGMT CO 2009 401k membership
Total participants, beginning-of-year	2009-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	176
Number of retired or separated participants receiving benefits	2009-01-01	15
Total of all active and inactive participants	2009-01-01	191
Total participants	2009-01-01	191

Form 5500 Responses for SENIOR STAR MGMT CO

2022: SENIOR STAR MGMT CO 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SENIOR STAR MGMT CO 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SENIOR STAR MGMT CO 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: SENIOR STAR MGMT CO 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 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: SENIOR STAR MGMT CO 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: SENIOR STAR MGMT CO 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: SENIOR STAR MGMT CO 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: SENIOR STAR MGMT CO 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SENIOR STAR MGMT CO 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SENIOR STAR MGMT CO 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SENIOR STAR MGMT CO 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SENIOR STAR MGMT CO 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SENIOR STAR MGMT CO 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

36074

Policy instance

Insurance contract or identification number	36074
Number of Individuals Covered	167
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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
Other welfare benefits provided	HOSPITAL,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-020448-00

Policy instance

Insurance contract or identification number	01-020448-00
Number of Individuals Covered	504
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,130
Total amount of fees paid to insurance company	USD $3,093
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $137,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $17,130
Amount paid for insurance broker fees	3093
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	241
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

922697

Policy instance

Insurance contract or identification number	922697
Number of Individuals Covered	359
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,294,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

922697

Policy instance

Insurance contract or identification number	922697
Number of Individuals Covered	448
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,726,651
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: 39616 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	301
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $2,296
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,296
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

36074

Policy instance

Insurance contract or identification number	36074
Number of Individuals Covered	380
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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
Other welfare benefits provided	HOSPITAL,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $91,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F023287

Policy instance

Insurance contract or identification number	F023287
Number of Individuals Covered	504
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,915
Total amount of fees paid to insurance company	USD $4,528
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $176,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,915
Amount paid for insurance broker fees	4528
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F023287

Policy instance

Insurance contract or identification number	F023287
Number of Individuals Covered	681
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $32,667
Total amount of fees paid to insurance company	USD $10,941
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $195,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,842
Amount paid for insurance broker fees	10941
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

36074

Policy instance

Insurance contract or identification number	36074
Number of Individuals Covered	212
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,125
Total amount of fees paid to insurance company	USD $1,193
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
Other welfare benefits provided	HOSPITAL,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $68,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,125
Amount paid for insurance broker fees	1193
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	492
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $-166
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,444,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $-166
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	337
Insurance policy start date	2019-11-01
Insurance policy end date	2020-10-31
Total amount of commissions paid to insurance broker	USD $131
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $131
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	344
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $1,548
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,548
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F023287

Policy instance

Insurance contract or identification number	F023287
Number of Individuals Covered	643
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $28,609
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $169,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,609
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

95222

Policy instance

Insurance contract or identification number	95222
Number of Individuals Covered	245
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,892
Total amount of fees paid to insurance company	USD $775
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
Other welfare benefits provided	HOSPITAL,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $62,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,892
Amount paid for insurance broker fees	775
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	527
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $51,770
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,413,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $51,770
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4056

Policy instance

Insurance contract or identification number	4056
Number of Individuals Covered	351
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,978
Total amount of fees paid to insurance company	USD $21,675
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,978
Amount paid for insurance broker fees	21675
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	321
Insurance policy start date	2016-11-01
Insurance policy end date	2017-10-31
Total amount of commissions paid to insurance broker	USD $1,479
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,479
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	544
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $97,152
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,224,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97,152
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

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

Policy contract number

875216G

Policy instance

Insurance contract or identification number	875216G
Number of Individuals Covered	615
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $31,643
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,643
Insurance broker organization code?	3
Insurance broker name	NFP CORPRATE SERVICES INC

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69861

Policy instance

Insurance contract or identification number	69861
Number of Individuals Covered	255
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $25,268
Other welfare benefits provided	CRITICAL ILLNESS & HOSPITAL CONFINE
Welfare Benefit Premiums Paid to Carrier	USD $36,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,268
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	311
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,363
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,363
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	508
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $96,527
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,508,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $96,527
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4056

Policy instance

Insurance contract or identification number	4056
Number of Individuals Covered	346
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $15,902
Total amount of fees paid to insurance company	USD $20,564
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,902
Amount paid for insurance broker fees	20564
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES LLC

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

Policy contract number

875216G

Policy instance

Insurance contract or identification number	875216G
Number of Individuals Covered	1337
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $31,908
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $166,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,908
Insurance broker organization code?	3
Insurance broker name	MASCHINO HUDELSON & ASSOCIATES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30045413

Policy instance

Insurance contract or identification number	30045413
Number of Individuals Covered	273
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,272
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,074
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4056

Policy instance

Insurance contract or identification number	4056
Number of Individuals Covered	324
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,610
Total amount of fees paid to insurance company	USD $18,650
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,610
Amount paid for insurance broker fees	18650
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	MASCHINO HUDELSON & ASSOCIATES

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06263

Policy instance

Insurance contract or identification number	06263
Number of Individuals Covered	539
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $22,709
Total amount of fees paid to insurance company	USD $178
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,557
Insurance broker organization code?	3
Amount paid for insurance broker fees	178
Additional information about fees paid to insurance broker	THIRD PARTY ADMINSTRATION FEES
Insurance broker name	AXA ASSISTANCE, USA

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	452
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $107,665
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,247,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,041
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES OK , LLC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4054

Policy instance

Insurance contract or identification number	4054
Number of Individuals Covered	302
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,183
Total amount of fees paid to insurance company	USD $9,913
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,164
Amount paid for insurance broker fees	4956
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	PLAN BENEFIT ANALYSTS OF TULSA INC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06263

Policy instance

Insurance contract or identification number	06263
Number of Individuals Covered	527
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $21,332
Total amount of fees paid to insurance company	USD $171
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,490
Insurance broker organization code?	3
Amount paid for insurance broker fees	171
Additional information about fees paid to insurance broker	THIRD PARTY ADMINSTRATION FEES
Insurance broker name	AXA ASSISTANCE, USA

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777640

Policy instance

Insurance contract or identification number	9777640
Number of Individuals Covered	388
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,269
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,302
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMP BENE SVC OF OK INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	422
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $79,566
Total amount of fees paid to insurance company	USD $4,500
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,590,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,286
Amount paid for insurance broker fees	4500
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMP BENE SVC OF OK INC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777640

Policy instance

Insurance contract or identification number	9777640
Number of Individuals Covered	296
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,820
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,820
Insurance broker organization code?	3
Insurance broker name	PLAN BENEFIT ANALYSTS OF TULSA INC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4054

Policy instance

Insurance contract or identification number	4054
Number of Individuals Covered	238
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,062
Total amount of fees paid to insurance company	USD $7,106
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,062
Amount paid for insurance broker fees	7106
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	PLAN BENEFIT ANALYSTS OF TULSA INC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06263

Policy instance

Insurance contract or identification number	06263
Number of Individuals Covered	455
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,135
Total amount of fees paid to insurance company	USD $157
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	157
Additional information about fees paid to insurance broker	THIRD PARTY ADMINSTRATION FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $9,135
Insurance broker name	PLAN BENEFIT ANALYSTS OF TULSA INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	365
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $71,156
Total amount of fees paid to insurance company	USD $2,290
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,422,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,156
Amount paid for insurance broker fees	2290
Additional information about fees paid to insurance broker	COMMISSIONS AND BONUS
Insurance broker organization code?	3
Insurance broker name	PLAN BENEFIT ANALYSTS OF TULSA INC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4054

Policy instance

Insurance contract or identification number	4054
Number of Individuals Covered	183
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,752
Total amount of fees paid to insurance company	USD $6,515
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	313
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $72,508
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,303,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777640

Policy instance

Insurance contract or identification number	9777640
Number of Individuals Covered	263
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,549
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06263

Policy instance

Insurance contract or identification number	06263
Number of Individuals Covered	410
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,367
Total amount of fees paid to insurance company	USD $134
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )

Policy contract number

613503

Policy instance

Insurance contract or identification number	613503
Number of Individuals Covered	297
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $51,020
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,057,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

4054

Policy instance

Insurance contract or identification number	4054
Number of Individuals Covered	173
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,707
Total amount of fees paid to insurance company	USD $4,416
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06263

Policy instance

Insurance contract or identification number	06263
Number of Individuals Covered	337
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,856
Total amount of fees paid to insurance company	USD $95
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9777640

Policy instance

Insurance contract or identification number	9777640
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 $1,160
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SENIOR STAR MANAGEMENT COMPANY
Employer identification number (EIN):	731220378
NAIC Classification:	531310