401k Plan data: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI plan

AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 401k Plan overview

Plan Name	AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI
Plan identification number	502

AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 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 Other welfare benefit cover

401k Sponsoring company profile

AMERICAN EAGLE FEDERAL CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN EAGLE FEDERAL CREDIT UNION

Employer identification number (EIN): 060329210

NAIC Classification: 522130
NAIC Description: Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01
502 2014-01-01
502 2013-01-01
502 2012-01-01 SUSAN M. BUSHNIK
502 2011-01-01 SUSAN M. BUSHNIK
502 2010-01-01 JOHN CONANT
502 2009-01-01 CANDICE M. BOVE

Plan Statistics for AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI

401k plan membership statisitcs for AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI

Measure Date Value
2015: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2015 401k membership
Total participants, beginning-of-year 2015-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 287
Total of all active and inactive participants 2015-01-01 287
2014: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2014 401k membership
Total participants, beginning-of-year 2014-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 207
Number of retired or separated participants receiving benefits 2014-01-01 9
Total of all active and inactive participants 2014-01-01 216
2013: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2013 401k membership
Total participants, beginning-of-year 2013-01-01 289
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 244
Number of retired or separated participants receiving benefits 2013-01-01 9
Total of all active and inactive participants 2013-01-01 253
2012: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2012 401k membership
Total participants, beginning-of-year 2012-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 280
Number of retired or separated participants receiving benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 289
2011: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2011 401k membership
Total participants, beginning-of-year 2011-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 269
Number of retired or separated participants receiving benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 279
2010: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2010 401k membership
Total participants, beginning-of-year 2010-01-01 270
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 232
Number of retired or separated participants receiving benefits 2010-01-01 11
Total of all active and inactive participants 2010-01-01 243
2009: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2009 401k membership
Total participants, beginning-of-year 2009-01-01 306
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 242
Number of retired or separated participants receiving benefits 2009-01-01 28
Total of all active and inactive participants 2009-01-01 270

Measure	Date	Value
2015: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2015 401k membership
Total participants, beginning-of-year	2015-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	287
Total of all active and inactive participants	2015-01-01	287
2014: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2014 401k membership
Total participants, beginning-of-year	2014-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	207
Number of retired or separated participants receiving benefits	2014-01-01	9
Total of all active and inactive participants	2014-01-01	216
2013: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2013 401k membership
Total participants, beginning-of-year	2013-01-01	289
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	244
Number of retired or separated participants receiving benefits	2013-01-01	9
Total of all active and inactive participants	2013-01-01	253
2012: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2012 401k membership
Total participants, beginning-of-year	2012-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	280
Number of retired or separated participants receiving benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	289
2011: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2011 401k membership
Total participants, beginning-of-year	2011-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	269
Number of retired or separated participants receiving benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	279
2010: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2010 401k membership
Total participants, beginning-of-year	2010-01-01	270
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	232
Number of retired or separated participants receiving benefits	2010-01-01	11
Total of all active and inactive participants	2010-01-01	243
2009: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2009 401k membership
Total participants, beginning-of-year	2009-01-01	306
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	242
Number of retired or separated participants receiving benefits	2009-01-01	28
Total of all active and inactive participants	2009-01-01	270

Form 5500 Responses for AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI

2015: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: AMERICAN EAGLE FEDERAL CREDIT UNION WELFARE BENEFI 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1959

Policy instance

Insurance contract or identification number	1959
Number of Individuals Covered	443
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $91,111
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,803,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91,111
Insurance broker organization code?	3
Insurance broker name	GORDON ST. JOHN

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AW8S

Policy instance

Insurance contract or identification number	G000AW8S
Number of Individuals Covered	288
Insurance policy start date	2015-04-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,161
Total amount of fees paid to insurance company	USD $5,989
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5989
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,161
Insurance broker name	PENTRA, INC.

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	254
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,194
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,194
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

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

Policy contract number

000000226275

Policy instance

Insurance contract or identification number	000000226275
Number of Individuals Covered	287
Insurance policy start date	2015-01-01
Insurance policy end date	2015-04-01
Total amount of commissions paid to insurance broker	USD $3,066
Total amount of fees paid to insurance company	USD $230
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,066
Amount paid for insurance broker fees	230
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	280
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
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

000000226276

Policy instance

Insurance contract or identification number	000000226276
Number of Individuals Covered	175
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,992
Total amount of fees paid to insurance company	USD $224
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFESTYLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,992
Amount paid for insurance broker fees	224
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

188

Policy instance

Insurance contract or identification number	188
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $587
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	WELLNESS
Welfare Benefit Premiums Paid to Carrier	USD $37,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $587
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AW8S

Policy instance

Insurance contract or identification number	G000AW8S
Number of Individuals Covered	250
Insurance policy start date	2015-04-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,309
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,309
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AW8S

Policy instance

Insurance contract or identification number	G000AW8S
Number of Individuals Covered	169
Insurance policy start date	2015-04-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,089
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $67,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,089
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	277
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,387
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,387
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	254
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,202
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,202
Insurance broker organization code?	3
Insurance broker name	PENTRA

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

8000489

Policy instance

Insurance contract or identification number	8000489
Number of Individuals Covered	9
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $810
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
Other welfare benefits provided	OVER 65 PLAN F WITH PART D
Welfare Benefit Premiums Paid to Carrier	USD $38,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $810
Insurance broker organization code?	3
Insurance broker name	PENTRA

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	278
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,161
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,161
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

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

Policy contract number

000000226275

Policy instance

Insurance contract or identification number	000000226275
Number of Individuals Covered	246
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,931
Total amount of fees paid to insurance company	USD $500
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $66,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,931
Amount paid for insurance broker fees	500
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

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

Policy contract number

226276

Policy instance

Insurance contract or identification number	226276
Number of Individuals Covered	173
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,035
Total amount of fees paid to insurance company	USD $603
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	LIFESTYLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $80,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,035
Amount paid for insurance broker fees	603
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	199
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $869
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
Other welfare benefits provided	WELLNESS
Welfare Benefit Premiums Paid to Carrier	USD $40,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $869
Insurance broker organization code?	3
Insurance broker name	PENTRA, INC.

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1959

Policy instance

Insurance contract or identification number	1959
Number of Individuals Covered	463
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $87,260
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 $2,684,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,260
Insurance broker organization code?	3
Insurance broker name	GORDON ST. JOHN

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	286
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	196
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,231
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
Other welfare benefits provided	WELLNESS
Welfare Benefit Premiums Paid to Carrier	USD $49,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,231
Insurance broker organization code?	3
Insurance broker name	NICHOLAS H. LAMOTTE/PENTRA

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

Policy contract number

000000226275

Policy instance

Insurance contract or identification number	000000226275
Number of Individuals Covered	285
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,834
Total amount of fees paid to insurance company	USD $578
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $77,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,834
Amount paid for insurance broker fees	578
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

226276

Policy instance

Insurance contract or identification number	226276
Number of Individuals Covered	169
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,419
Total amount of fees paid to insurance company	USD $631
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	LIFESTYLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $84,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,419
Amount paid for insurance broker fees	631
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800085

Policy instance

Insurance contract or identification number	800085
Number of Individuals Covered	8
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $704
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
Other welfare benefits provided	OVER 65 PLAN F WITH PART D
Welfare Benefit Premiums Paid to Carrier	USD $46,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $704
Insurance broker organization code?	3
Insurance broker name	NICHOLAS H. LAMOTTE/PENTRA

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1959

Policy instance

Insurance contract or identification number	1959
Number of Individuals Covered	462
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $88,210
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 $2,714,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,210
Insurance broker organization code?	3
Insurance broker name	NICHOLAS H. LAMOTTE/PENTRA

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	258
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,160
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 $21,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,042
Insurance broker organization code?	3
Insurance broker name	PENTRA

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	294
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	276
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,430
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,430
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES

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

Policy contract number

226276

Policy instance

Insurance contract or identification number	226276
Number of Individuals Covered	178
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,279
Total amount of fees paid to insurance company	USD $1,945
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	LIFESTYLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $92,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,279
Amount paid for insurance broker fees	1945
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATIONPAID
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	280
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1959

Policy instance

Insurance contract or identification number	1959
Number of Individuals Covered	486
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $118,443
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 $2,368,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118,443
Insurance broker organization code?	3
Insurance broker name	NICHOLAS H. LAMOTTE

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800085

Policy instance

Insurance contract or identification number	800085
Number of Individuals Covered	9
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $802
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
Other welfare benefits provided	OVER 65 PLAN F WITH PART D
Welfare Benefit Premiums Paid to Carrier	USD $48,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $802
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	277
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,820
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,820
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

000000226275

Policy instance

Insurance contract or identification number	000000226275
Number of Individuals Covered	280
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,106
Total amount of fees paid to insurance company	USD $1,700
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $82,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,106
Amount paid for insurance broker fees	1700
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WELLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	256
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,161
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 $21,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,161
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	240
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,143
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 $21,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	280
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1959

Policy instance

Insurance contract or identification number	1959
Number of Individuals Covered	482
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $113,619
Total amount of fees paid to insurance company	USD $13,980
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 $2,272,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800085

Policy instance

Insurance contract or identification number	800085
Number of Individuals Covered	10
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,000
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
Other welfare benefits provided	OVER 65 PLAN F WITH PART D
Welfare Benefit Premiums Paid to Carrier	USD $59,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	266
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,303
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 961069

Policy instance

Insurance contract or identification number	OK 961069
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-10-14
Total amount of commissions paid to insurance broker	USD $757
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,017
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

FLX961018

Policy instance

Insurance contract or identification number	FLX961018
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-10-14
Total amount of commissions paid to insurance broker	USD $12,111
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
Welfare Benefit Premiums Paid to Carrier	USD $80,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LTD109994

Policy instance

Insurance contract or identification number	LTD109994
Number of Individuals Covered	231
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,707
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,136
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

000000226275

Policy instance

Insurance contract or identification number	000000226275
Number of Individuals Covered	269
Insurance policy start date	2011-10-15
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $713
Total amount of fees paid to insurance company	USD $178
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 $7,134
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

FLX961018

Policy instance

Insurance contract or identification number	FLX961018
Number of Individuals Covered	498
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $15,347
Total amount of fees paid to insurance company	USD $1,470
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 $102,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,347
Amount paid for insurance broker fees	1470
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

OK 961069

Policy instance

Insurance contract or identification number	OK 961069
Number of Individuals Covered	304
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $902
Total amount of fees paid to insurance company	USD $88
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $902
Amount paid for insurance broker fees	88
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

4224

Policy instance

Insurance contract or identification number	4224
Number of Individuals Covered	269
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $16,277
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,277
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800489

Policy instance

Insurance contract or identification number	800489
Number of Individuals Covered	231
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $59,950
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 $2,311,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,950
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

HARRIS, ROTHENBERG INTERNATIONAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	280
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	WORK/LIFE SERVICES EAP
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

12228219

Policy instance

Insurance contract or identification number	12228219
Number of Individuals Covered	242
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,157
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 $21,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,157
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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

Policy contract number

LTD109994

Policy instance

Insurance contract or identification number	LTD109994
Number of Individuals Covered	231
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,815
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,815
Insurance broker organization code?	3
Insurance broker name	IBS, INC

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800489

Policy instance

Insurance contract or identification number	800489
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,110
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 $52,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,110
Insurance broker organization code?	3
Insurance broker name	INTEGRATED BENEFIT SERVICES INC

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Company Name:	AMERICAN EAGLE FEDERAL CREDIT UNION
Employer identification number (EIN):	060329210
NAIC Classification:	522130
NAIC Description:	Credit Unions