401k Plan data: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN plan

THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 401k Plan overview

Plan Name	THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN
Plan identification number	501

THE NEW MEXICAN FLEX SPENDING (CAFETERIA) 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

THE NEW MEXICAN, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE NEW MEXICAN, INC.

Employer identification number (EIN): 850095953

NAIC Classification: 511110
NAIC Description: Newspaper Publishers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-03-01
501 2021-03-01
501 2020-03-01
501 2019-03-01
501 2018-03-01 WILLIAM A SIMMONS
501 2017-03-01 WILLIAM A SIMMONS
501 2016-03-01 WILLIAM A SIMMONS
501 2015-03-01 WILLIAM A SIMMONS
501 2014-03-01 WILLIAM A SIMMONS
501 2013-03-01 WILLIAM A SIMMONS
501 2012-03-01 WILLIAM A SIMMONS
501 2011-03-01 WILLIAM A SIMMONS
501 2009-03-01 WILLIAM A SIMMONS

Plan Statistics for THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN

401k plan membership statisitcs for THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN

Measure Date Value
2022: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 151
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 161
Total of all active and inactive participants 2022-03-01 161
Total participants 2022-03-01 161
2021: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 145
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 151
Total of all active and inactive participants 2021-03-01 151
Total participants 2021-03-01 151
2020: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 147
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 145
Total of all active and inactive participants 2020-03-01 145
Total participants 2020-03-01 145
2019: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-03-01 145
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 147
Total of all active and inactive participants 2019-03-01 147
Total participants 2019-03-01 147
Number of participants with account balances 2019-03-01 0
2018: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-03-01 178
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 145
Total of all active and inactive participants 2018-03-01 145
Total participants 2018-03-01 145
2017: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-03-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 178
Total of all active and inactive participants 2017-03-01 178
Total participants 2017-03-01 178
2016: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-03-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 167
Total of all active and inactive participants 2016-03-01 167
Total participants 2016-03-01 0
2015: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 121
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 131
Total of all active and inactive participants 2015-03-01 131
Total participants 2015-03-01 0
2014: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-01 147
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 121
Total of all active and inactive participants 2014-03-01 121
Total participants 2014-03-01 0
2013: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 147
Total of all active and inactive participants 2013-03-01 147
Total participants 2013-03-01 0
2012: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 138
Total of all active and inactive participants 2012-03-01 138
Total participants 2012-03-01 0
2011: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-03-01 127
Total number of active participants reported on line 7a of the Form 5500 2011-03-01 139
Total of all active and inactive participants 2011-03-01 139
Total participants 2011-03-01 139
2009: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-03-01 138
Total number of active participants reported on line 7a of the Form 5500 2009-03-01 130
Total of all active and inactive participants 2009-03-01 130
Total participants 2009-03-01 130

Measure	Date	Value
2022: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	151
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	161
Total of all active and inactive participants	2022-03-01	161
Total participants	2022-03-01	161
2021: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	145
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	151
Total of all active and inactive participants	2021-03-01	151
Total participants	2021-03-01	151
2020: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	147
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	145
Total of all active and inactive participants	2020-03-01	145
Total participants	2020-03-01	145
2019: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-03-01	145
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	147
Total of all active and inactive participants	2019-03-01	147
Total participants	2019-03-01	147
Number of participants with account balances	2019-03-01	0
2018: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-03-01	178
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	145
Total of all active and inactive participants	2018-03-01	145
Total participants	2018-03-01	145
2017: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-03-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	178
Total of all active and inactive participants	2017-03-01	178
Total participants	2017-03-01	178
2016: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-03-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	167
Total of all active and inactive participants	2016-03-01	167
Total participants	2016-03-01	0
2015: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	121
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	131
Total of all active and inactive participants	2015-03-01	131
Total participants	2015-03-01	0
2014: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-01	147
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	121
Total of all active and inactive participants	2014-03-01	121
Total participants	2014-03-01	0
2013: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	147
Total of all active and inactive participants	2013-03-01	147
Total participants	2013-03-01	0
2012: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	138
Total of all active and inactive participants	2012-03-01	138
Total participants	2012-03-01	0
2011: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-03-01	127
Total number of active participants reported on line 7a of the Form 5500	2011-03-01	139
Total of all active and inactive participants	2011-03-01	139
Total participants	2011-03-01	139
2009: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-03-01	138
Total number of active participants reported on line 7a of the Form 5500	2009-03-01	130
Total of all active and inactive participants	2009-03-01	130
Total participants	2009-03-01	130

Form 5500 Responses for THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN

2022: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2016 form 5500 responses
2016-03-01	Type of plan entity	Single employer plan
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2011 form 5500 responses
2011-03-01	Type of plan entity	Single employer plan
2011-03-01	Plan funding arrangement – Insurance	Yes
2011-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-03-01	Plan benefit arrangement – Insurance	Yes
2011-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: THE NEW MEXICAN FLEX SPENDING (CAFETERIA) PLAN 2009 form 5500 responses
2009-03-01	Type of plan entity	Single employer plan
2009-03-01	Plan funding arrangement – Insurance	Yes
2009-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-03-01	Plan benefit arrangement – Insurance	Yes
2009-03-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

SGD608641000000

Policy instance

Insurance contract or identification number	SGD608641000000
Number of Individuals Covered	161
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	106
Total amount of commissions paid to insurance broker	USD $1,105
Total amount of fees paid to insurance company	USD $50,293
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,251,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,105
Amount paid for insurance broker fees	50293
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES PAID
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0618534

Policy instance

Insurance contract or identification number	0618534
Number of Individuals Covered	101
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0618534

Policy instance

Insurance contract or identification number	0618534
Number of Individuals Covered	107
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

SGD608642000000

Policy instance

Insurance contract or identification number	SGD608642000000
Number of Individuals Covered	161
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

SGM608156000000

Policy instance

Insurance contract or identification number	SGM608156000000
Number of Individuals Covered	161
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

SOK605959934000

Policy instance

Insurance contract or identification number	SOK605959934000
Number of Individuals Covered	161
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0348800000

Policy instance

Insurance contract or identification number	0348800000
Number of Individuals Covered	7
Total amount of commissions paid to insurance broker	USD $100
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	115
Total amount of commissions paid to insurance broker	USD $1,074
Total amount of fees paid to insurance company	USD $47,845
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,200,945
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
Amount paid for insurance broker fees	47845
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES PAID

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0618534

Policy instance

Insurance contract or identification number	0618534
Number of Individuals Covered	108
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK605959

Policy instance

Insurance contract or identification number	SOK605959
Number of Individuals Covered	148
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608641

Policy instance

Insurance contract or identification number	SGD608641
Number of Individuals Covered	148
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608642

Policy instance

Insurance contract or identification number	SGD608642
Number of Individuals Covered	148
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM608156

Policy instance

Insurance contract or identification number	SGM608156
Number of Individuals Covered	151
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	110
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,089,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

E4242210

Policy instance

Insurance contract or identification number	E4242210
Number of Individuals Covered	5
Total amount of commissions paid to insurance broker	USD $3
Other welfare benefits provided	CRITICAL ILLNESS CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,108
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

DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )

Policy contract number

13283E

Policy instance

Insurance contract or identification number	13283E
Total amount of commissions paid to insurance broker	USD $460
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $460

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM608156

Policy instance

Insurance contract or identification number	SGM608156
Number of Individuals Covered	18
Total amount of commissions paid to insurance broker	USD $1,897
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,897

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608641

Policy instance

Insurance contract or identification number	SGD608641
Number of Individuals Covered	123
Total amount of commissions paid to insurance broker	USD $2,339
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,339

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608642

Policy instance

Insurance contract or identification number	SGD608642
Number of Individuals Covered	126
Total amount of commissions paid to insurance broker	USD $2,283
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,283

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK605959

Policy instance

Insurance contract or identification number	SOK605959
Number of Individuals Covered	142
Total amount of commissions paid to insurance broker	USD $248
Total amount of fees paid to insurance company	USD $43,783
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	43783
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES PAID
Commission paid to Insurance Broker	USD $248

DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )

Policy contract number

0013283

Policy instance

Insurance contract or identification number	0013283
Number of Individuals Covered	145
Total amount of commissions paid to insurance broker	USD $2,573
Total amount of fees paid to insurance company	USD $6,056
Welfare Benefit Premiums Paid to Carrier	USD $44,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,573
Amount paid for insurance broker fees	6056
Additional information about fees paid to insurance broker	ADMIN SERVICE FEES

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0348800000

Policy instance

Insurance contract or identification number	0348800000
Number of Individuals Covered	9
Total amount of commissions paid to insurance broker	USD $125
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	136
Total amount of commissions paid to insurance broker	USD $5,100
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,116,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,100

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

Policy contract number

E4242210

Policy instance

Insurance contract or identification number	E4242210
Number of Individuals Covered	5
Total amount of commissions paid to insurance broker	USD $4
Other welfare benefits provided	CRITICAL ILLNESS CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,108
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

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0348800000

Policy instance

Insurance contract or identification number	0348800000
Number of Individuals Covered	10
Total amount of commissions paid to insurance broker	USD $132
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	93
Total amount of commissions paid to insurance broker	USD $906
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $906

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM608156

Policy instance

Insurance contract or identification number	SGM608156
Number of Individuals Covered	125
Total amount of commissions paid to insurance broker	USD $1,760
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,760

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608641

Policy instance

Insurance contract or identification number	SGD608641
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $2,009
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,009

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608642

Policy instance

Insurance contract or identification number	SGD608642
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $1,980
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,980

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK605959

Policy instance

Insurance contract or identification number	SOK605959
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $218
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $218

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	144
Total amount of commissions paid to insurance broker	USD $5,019
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $944,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,019

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

Policy contract number

E4242210

Policy instance

Insurance contract or identification number	E4242210
Number of Individuals Covered	5
Total amount of commissions paid to insurance broker	USD $3
Other welfare benefits provided	CRITICAL ILLNESS CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0348800000

Policy instance

Insurance contract or identification number	0348800000
Number of Individuals Covered	12
Total amount of commissions paid to insurance broker	USD $178
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $3,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $178

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	100
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM608156

Policy instance

Insurance contract or identification number	SGM608156
Number of Individuals Covered	145
Total amount of commissions paid to insurance broker	USD $2,105
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,105

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608641

Policy instance

Insurance contract or identification number	SGD608641
Number of Individuals Covered	145
Total amount of commissions paid to insurance broker	USD $2,557
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,557

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK605959

Policy instance

Insurance contract or identification number	SOK605959
Number of Individuals Covered	145
Total amount of commissions paid to insurance broker	USD $263
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $263

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608642

Policy instance

Insurance contract or identification number	SGD608642
Number of Individuals Covered	145
Total amount of commissions paid to insurance broker	USD $2,513
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,513

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

Policy contract number

D4004

Policy instance

Insurance contract or identification number	D4004
Number of Individuals Covered	39
Total amount of commissions paid to insurance broker	USD $2,716
Other welfare benefits provided	ACCIDENT, CRIT ILLNESS, SHOP-HOSP
Welfare Benefit Premiums Paid to Carrier	USD $5,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,716

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK605959

Policy instance

Insurance contract or identification number	SOK605959
Number of Individuals Covered	160
Total amount of commissions paid to insurance broker	USD $229
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $229
Insurance broker name	DANIELS INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608642

Policy instance

Insurance contract or identification number	SGD608642
Number of Individuals Covered	160
Total amount of commissions paid to insurance broker	USD $2,021
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,021
Insurance broker name	DANIELS INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608641

Policy instance

Insurance contract or identification number	SGD608641
Number of Individuals Covered	160
Total amount of commissions paid to insurance broker	USD $2,060
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,060
Insurance broker name	DANIELS INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM608156

Policy instance

Insurance contract or identification number	SGM608156
Number of Individuals Covered	178
Total amount of commissions paid to insurance broker	USD $1,731
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,731
Insurance broker name	DANIELS INSURANCE AGENCY

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	96
Total amount of commissions paid to insurance broker	USD $929
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $929
Insurance broker name	DANIELS INSURANCE

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0348800000

Policy instance

Insurance contract or identification number	0348800000
Number of Individuals Covered	18
Total amount of commissions paid to insurance broker	USD $242
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $5,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $242
Insurance broker name	DANIELS INSURANCE AGENCY

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

Policy contract number

E4242210

Policy instance

Insurance contract or identification number	E4242210
Number of Individuals Covered	6
Total amount of commissions paid to insurance broker	USD $3
Other welfare benefits provided	CRITICAL ILLNESS CARE
Welfare Benefit Premiums Paid to Carrier	USD $1,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3
Insurance broker name	DANIELS INSURANCE INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618534

Policy instance

Insurance contract or identification number	00618534
Number of Individuals Covered	143
Total amount of commissions paid to insurance broker	USD $5,343
Total amount of fees paid to insurance company	USD $35,542
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $937,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,343
Amount paid for insurance broker fees	35542
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE

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

Policy contract number

000010139919

Policy instance

Insurance contract or identification number	000010139919
Number of Individuals Covered	161
Total amount of commissions paid to insurance broker	USD $1,900
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,900
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

112273

Policy instance

Insurance contract or identification number	112273
Number of Individuals Covered	238
Total amount of commissions paid to insurance broker	USD $536
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $536
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

903404-099

Policy instance

Insurance contract or identification number	903404-099
Number of Individuals Covered	144
Total amount of commissions paid to insurance broker	USD $4,726
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,726
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	73
Total amount of commissions paid to insurance broker	USD $828
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $828
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE

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

Policy contract number

000010139918000

Policy instance

Insurance contract or identification number	000010139918000
Number of Individuals Covered	163
Total amount of commissions paid to insurance broker	USD $3,260
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,260
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	30
Total amount of commissions paid to insurance broker	USD $1,829
Other welfare benefits provided	SPOUSE & DEPENDENT LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,829
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00613212

Policy instance

Insurance contract or identification number	00613212
Number of Individuals Covered	131
Total amount of commissions paid to insurance broker	USD $45,255
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,255
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

000010139917000

Policy instance

Insurance contract or identification number	000010139917000
Number of Individuals Covered	165
Total amount of commissions paid to insurance broker	USD $1,800
Other welfare benefits provided	LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,800
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

903404-099

Policy instance

Insurance contract or identification number	903404-099
Number of Individuals Covered	148
Total amount of commissions paid to insurance broker	USD $4,873
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,873
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	69
Total amount of commissions paid to insurance broker	USD $770
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $770
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

000010139919000

Policy instance

Insurance contract or identification number	000010139919000
Number of Individuals Covered	144
Total amount of commissions paid to insurance broker	USD $1,928
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,928
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000010139917000

Policy instance

Insurance contract or identification number	000010139917000
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $1,780
Other welfare benefits provided	LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,780
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE

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

Policy contract number

000010139918000

Policy instance

Insurance contract or identification number	000010139918000
Number of Individuals Covered	146
Total amount of commissions paid to insurance broker	USD $3,300
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,300
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

655163

Policy instance

Insurance contract or identification number	655163
Number of Individuals Covered	123
Total amount of commissions paid to insurance broker	USD $28,098
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $701,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,098
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

661

Policy instance

Insurance contract or identification number	661
Number of Individuals Covered	94
Total amount of commissions paid to insurance broker	USD $3,292
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,292
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	62
Total amount of commissions paid to insurance broker	USD $754
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $754
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 )

Policy contract number

20567700

Policy instance

Insurance contract or identification number	20567700
Number of Individuals Covered	125
Total amount of commissions paid to insurance broker	USD $21,708
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $539,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,708
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

000010139917000

Policy instance

Insurance contract or identification number	000010139917000
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $1,787
Other welfare benefits provided	LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,787
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000010139918000

Policy instance

Insurance contract or identification number	000010139918000
Number of Individuals Covered	146
Total amount of commissions paid to insurance broker	USD $2,778
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,778
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000010139919000

Policy instance

Insurance contract or identification number	000010139919000
Number of Individuals Covered	147
Total amount of commissions paid to insurance broker	USD $1,899
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,899
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

40000100012992

Policy instance

Insurance contract or identification number	40000100012992
Number of Individuals Covered	41
Other welfare benefits provided	CHILD & SPOUSE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30024935

Policy instance

Insurance contract or identification number	30024935
Number of Individuals Covered	68
Total amount of commissions paid to insurance broker	USD $834
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $834
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE

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

Policy contract number

00001D023650000

Policy instance

Insurance contract or identification number	00001D023650000
Number of Individuals Covered	105
Total amount of commissions paid to insurance broker	USD $2,732
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,732
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 )

Policy contract number

20567700

Policy instance

Insurance contract or identification number	20567700
Number of Individuals Covered	132
Total amount of commissions paid to insurance broker	USD $26,589
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $664,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,589
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05982453

Policy instance

Insurance contract or identification number	KM05982453
Total amount of commissions paid to insurance broker	USD $338
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $338
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

000010139917000

Policy instance

Insurance contract or identification number	000010139917000
Number of Individuals Covered	138
Total amount of commissions paid to insurance broker	USD $2,173
Total amount of fees paid to insurance company	USD $341
Other welfare benefits provided	LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,173
Amount paid for insurance broker fees	341
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000010139918000

Policy instance

Insurance contract or identification number	000010139918000
Number of Individuals Covered	136
Total amount of commissions paid to insurance broker	USD $4,563
Total amount of fees paid to insurance company	USD $533
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,888
Amount paid for insurance broker fees	248
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE INC

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

Policy contract number

000010139919000

Policy instance

Insurance contract or identification number	000010139919000
Number of Individuals Covered	136
Total amount of commissions paid to insurance broker	USD $1,856
Total amount of fees paid to insurance company	USD $272
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,856
Amount paid for insurance broker fees	272
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

000010139919000

Policy instance

Insurance contract or identification number	000010139919000
Number of Individuals Covered	136
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $1,608
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010139917000

Policy instance

Insurance contract or identification number	000010139917000
Number of Individuals Covered	137
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $1,877
Other welfare benefits provided	LIFE AND AD&D
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

112227

Policy instance

Insurance contract or identification number	112227
Number of Individuals Covered	139
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $28,553
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05982453

Policy instance

Insurance contract or identification number	KM05982453
Number of Individuals Covered	232
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $2,386
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010139918000

Policy instance

Insurance contract or identification number	000010139918000
Number of Individuals Covered	136
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $2,318
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

N99646

Policy instance

Insurance contract or identification number	N99646
Number of Individuals Covered	109
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $4,232
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,232
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

200794

Policy instance

Insurance contract or identification number	200794
Number of Individuals Covered	150
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $2,705
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,705
Insurance broker organization code?	3
Insurance broker name	DANIELS INS AGENCY INC

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

Policy contract number

200794

Policy instance

Insurance contract or identification number	200794
Number of Individuals Covered	150
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $1,827
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,827
Insurance broker organization code?	3
Insurance broker name	DANIELS INS AGENCY INC

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

Policy contract number

N12227

Policy instance

Insurance contract or identification number	N12227
Number of Individuals Covered	161
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $33,179
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $833,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,179
Insurance broker organization code?	3
Insurance broker name	DANIELS INSURANCE AGENCY INC

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

Policy contract number

200794

Policy instance

Insurance contract or identification number	200794
Number of Individuals Covered	150
Insurance policy start date	2009-03-01
Insurance policy end date	2010-02-28
Total amount of commissions paid to insurance broker	USD $2,116
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,116
Insurance broker organization code?	3
Insurance broker name	DANIELS INS AGENCY INC

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Employer identification number (EIN):	850095953
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