401k Plan data: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN plan

LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN
Plan identification number	505

LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

LAWRENCE MANAGEMENT SERVICES has sponsored the creation of one or more 401k plans.

Company Name: LAWRENCE MANAGEMENT SERVICES

Employer identification number (EIN): 751743504

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2018-09-01 NEAL HOOVER 2019-11-14 JAY LAWRENCE 2019-11-14
505 2017-09-01
505 2016-09-01
505 2015-09-01
505 2014-09-01
505 2013-09-01
505 2012-09-01 NEAL HOOVER
505 2011-09-01 NEAL HOOVER
505 2009-09-01 NEAL HOOVER

Plan Statistics for LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN

Measure Date Value
2018: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-09-01 92
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 58
Total of all active and inactive participants 2018-09-01 58
2017: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 106
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 92
Total of all active and inactive participants 2017-09-01 92
2016: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 207
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 106
Total of all active and inactive participants 2016-09-01 106
2015: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 238
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 207
Total of all active and inactive participants 2015-09-01 207
2014: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 221
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 238
Total of all active and inactive participants 2014-09-01 238
2013: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 205
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 221
Total of all active and inactive participants 2013-09-01 221
2012: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 199
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 205
Total of all active and inactive participants 2012-09-01 205
2011: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 207
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 199
Total of all active and inactive participants 2011-09-01 199
2009: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 210
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 211
Total of all active and inactive participants 2009-09-01 211

Measure	Date	Value
2018: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	92
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	58
Total of all active and inactive participants	2018-09-01	58
2017: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	106
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	92
Total of all active and inactive participants	2017-09-01	92
2016: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	207
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	106
Total of all active and inactive participants	2016-09-01	106
2015: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	238
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	207
Total of all active and inactive participants	2015-09-01	207
2014: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	221
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	238
Total of all active and inactive participants	2014-09-01	238
2013: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	205
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	221
Total of all active and inactive participants	2013-09-01	221
2012: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	199
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	205
Total of all active and inactive participants	2012-09-01	205
2011: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	207
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	199
Total of all active and inactive participants	2011-09-01	199
2009: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	210
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	211
Total of all active and inactive participants	2009-09-01	211

Form 5500 Responses for LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN

2018: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: LAWRENCE MANAGEMENT SERVICES FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	This submission is the final filing	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	92
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $2,229
Total amount of fees paid to insurance company	USD $308
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,229
Amount paid for insurance broker fees	308
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	35
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $2,917
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,917
Insurance broker organization code?	3

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	92
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $659
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $659
Insurance broker organization code?	3

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	85
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $14,455
Total amount of fees paid to insurance company	USD $1,224
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,455
Amount paid for insurance broker fees	1224
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	30
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $3,179
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,179
Insurance broker organization code?	3

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	115
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $17,644
Total amount of fees paid to insurance company	USD $1,308
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,644
Amount paid for insurance broker fees	1308
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	105
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $845
Total amount of fees paid to insurance company	USD $16
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $845
Insurance broker organization code?	3
Amount paid for insurance broker fees	16
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	41
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $3,739
Total amount of fees paid to insurance company	USD $66
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $24,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,739
Insurance broker organization code?	3
Amount paid for insurance broker fees	66
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	35
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $5,816
Total amount of fees paid to insurance company	USD $81
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,816
Insurance broker organization code?	3
Amount paid for insurance broker fees	81
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	134
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $3,255
Total amount of fees paid to insurance company	USD $380
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,255
Amount paid for insurance broker fees	380
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	172
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $37,262
Total amount of fees paid to insurance company	USD $3,084
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $247,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,262
Amount paid for insurance broker fees	3084
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7215411

Policy instance

Insurance contract or identification number	E7215411
Number of Individuals Covered	1
Insurance policy start date	2014-09-07
Insurance policy end date	2015-09-06
Total amount of commissions paid to insurance broker	USD $181
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128
Insurance broker organization code?	3
Insurance broker name	SAGENERAL AGENCY, INC.

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	207
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $1,867
Total amount of fees paid to insurance company	USD $93
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,867
Insurance broker organization code?	3
Amount paid for insurance broker fees	93
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	47
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $6,641
Total amount of fees paid to insurance company	USD $332
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $43,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,641
Insurance broker organization code?	3
Amount paid for insurance broker fees	332
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	40
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $9,854
Total amount of fees paid to insurance company	USD $370
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,854
Insurance broker organization code?	3
Amount paid for insurance broker fees	370
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	202
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $7,170
Total amount of fees paid to insurance company	USD $139
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,170
Amount paid for insurance broker fees	139
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	68
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $9,329
Total amount of fees paid to insurance company	USD $350
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,329
Insurance broker organization code?	3
Amount paid for insurance broker fees	350
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	305
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $2,442
Total amount of fees paid to insurance company	USD $197
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,442
Amount paid for insurance broker fees	197
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	79
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $7,027
Total amount of fees paid to insurance company	USD $351
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,027
Insurance broker organization code?	3
Amount paid for insurance broker fees	351
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	236
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,986
Total amount of fees paid to insurance company	USD $99
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,986
Insurance broker organization code?	3
Amount paid for insurance broker fees	99
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5472331

Policy instance

Insurance contract or identification number	5472331
Number of Individuals Covered	181
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $7,070
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 $70,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,070
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	322
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $37,131
Total amount of fees paid to insurance company	USD $2,292
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 $269,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,131
Amount paid for insurance broker fees	2292
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5472331

Policy instance

Insurance contract or identification number	5472331
Number of Individuals Covered	177
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $6,039
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 $60,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,039
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	379
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $40,962
Total amount of fees paid to insurance company	USD $2,304
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 $255,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,962
Amount paid for insurance broker fees	2304
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	251
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,213
Total amount of fees paid to insurance company	USD $111
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,213
Insurance broker organization code?	3
Amount paid for insurance broker fees	111
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	95
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $6,642
Total amount of fees paid to insurance company	USD $332
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $44,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,642
Insurance broker organization code?	3
Amount paid for insurance broker fees	332
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	141
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $2,041
Total amount of fees paid to insurance company	USD $237
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,041
Amount paid for insurance broker fees	237
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	72
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $7,359
Total amount of fees paid to insurance company	USD $276
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,359
Insurance broker organization code?	3
Amount paid for insurance broker fees	276
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	295
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $32,648
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 $268,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,648
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	223
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,752
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,669
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	52
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $5,063
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,822
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	34
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $5,632
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,428
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	156
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,496
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,496
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7215411

Policy instance

Insurance contract or identification number	E7215411
Number of Individuals Covered	1
Insurance policy start date	2011-09-07
Insurance policy end date	2012-09-06
Total amount of commissions paid to insurance broker	USD $222
Total amount of fees paid to insurance company	USD $96
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
Welfare Benefit Premiums Paid to Carrier	USD $2,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $158
Amount paid for insurance broker fees	91
Insurance broker organization code?	3
Insurance broker name	SA GENERAL AGENCY, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

GROUP #K336

Policy instance

Insurance contract or identification number	GROUP #K336
Number of Individuals Covered	192
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $4,534
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 $45,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,534
Insurance broker organization code?	3
Insurance broker name	TOMMY MORRIS AGENCY, LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	67
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,538
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

595512

Policy instance

Insurance contract or identification number	595512
Number of Individuals Covered	45
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $4,353
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,980
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

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	290
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $36,166
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 $286,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

GROUP #K336

Policy instance

Insurance contract or identification number	GROUP #K336
Number of Individuals Covered	171
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $4,340
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 $43,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	201
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $1,660
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	59
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $5,202
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

572852

Policy instance

Insurance contract or identification number	572852
Number of Individuals Covered	64
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $5,244
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

572851

Policy instance

Insurance contract or identification number	572851
Number of Individuals Covered	188
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $1,908
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

GROUP #K336

Policy instance

Insurance contract or identification number	GROUP #K336
Number of Individuals Covered	193
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $4,715
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 $47,153
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

22927

Policy instance

Insurance contract or identification number	22927
Number of Individuals Covered	301
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $38,996
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 $177,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-034192

Policy instance

Insurance contract or identification number	010-034192
Number of Individuals Covered	158
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $1,451
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LAWRENCE MANAGEMENT SERVICES
Employer identification number (EIN):	751743504
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2018-09-01	NEAL HOOVER	2019-11-14	JAY LAWRENCE	2019-11-14
505	2017-09-01
505	2016-09-01
505	2015-09-01
505	2014-09-01
505	2013-09-01
505	2012-09-01	NEAL HOOVER
505	2011-09-01	NEAL HOOVER
505	2009-09-01	NEAL HOOVER