401k Plan data: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN plan

DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN
Plan identification number	503

DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

DAVID J THOMPSON MAILING CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: DAVID J THOMPSON MAILING CORPORATION

Employer identification number (EIN): 112069062

NAIC Classification: 323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-02-01 DAVID J THOMPSON 2019-11-05
503 2017-02-01
503 2016-02-01
503 2015-02-01
503 2014-02-01
503 2013-02-01
503 2012-02-01 WILLIAM A PEYSSON WILLIAM A PEYSSON 2013-08-27
503 2011-02-01 WILLIAM A PEYSSON WILLIAM A PEYSSON 2012-06-29
503 2009-02-01 WILLIAM A PEYSSON WILLIAM A PEYSSON 2010-08-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2018-02-01	DAVID J THOMPSON	2019-11-05
503	2017-02-01
503	2016-02-01
503	2015-02-01
503	2014-02-01
503	2013-02-01
503	2012-02-01	WILLIAM A PEYSSON		WILLIAM A PEYSSON	2013-08-27
503	2011-02-01	WILLIAM A PEYSSON		WILLIAM A PEYSSON	2012-06-29
503	2009-02-01	WILLIAM A PEYSSON		WILLIAM A PEYSSON	2010-08-20

Plan Statistics for DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN

401k plan membership statisitcs for DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN

Measure Date Value
2018: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-02-01 118
Total number of active participants reported on line 7a of the Form 5500 2018-02-01 96
Total of all active and inactive participants 2018-02-01 96
2017: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-02-01 130
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 118
Total of all active and inactive participants 2017-02-01 118
2016: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-02-01 117
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 130
Total of all active and inactive participants 2016-02-01 130
2015: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-02-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 117
Total of all active and inactive participants 2015-02-01 117
2014: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 127
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 114
Total of all active and inactive participants 2014-02-01 114
2013: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 155
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 127
Total of all active and inactive participants 2013-02-01 127
2012: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 116
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 155
Total of all active and inactive participants 2012-02-01 155
2011: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 133
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 116
Total of all active and inactive participants 2011-02-01 116
2009: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 188
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 160
Total of all active and inactive participants 2009-02-01 160

Measure	Date	Value
2018: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-02-01	118
Total number of active participants reported on line 7a of the Form 5500	2018-02-01	96
Total of all active and inactive participants	2018-02-01	96
2017: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-01	130
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	118
Total of all active and inactive participants	2017-02-01	118
2016: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	117
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	130
Total of all active and inactive participants	2016-02-01	130
2015: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	117
Total of all active and inactive participants	2015-02-01	117
2014: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	127
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	114
Total of all active and inactive participants	2014-02-01	114
2013: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	155
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	127
Total of all active and inactive participants	2013-02-01	127
2012: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	116
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	155
Total of all active and inactive participants	2012-02-01	155
2011: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	133
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	116
Total of all active and inactive participants	2011-02-01	116
2009: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	188
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	160
Total of all active and inactive participants	2009-02-01	160

Form 5500 Responses for DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN

2018: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2018 form 5500 responses
2018-02-01	Type of plan entity	Single employer plan
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2017: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2016: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2015: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2014: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2012: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2009: DAVID J THOMPSON MAILING CORPORATION LIFE & DISABILITY PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	This submission is the final filing	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GLTD0AZWH

Policy instance

Insurance contract or identification number	GLTD0AZWH
Number of Individuals Covered	22
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $394
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $394
Insurance broker organization code?	3

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

Policy contract number

GUPR0AZWH

Policy instance

Insurance contract or identification number	GUPR0AZWH
Number of Individuals Covered	32
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $1,672
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,672
Insurance broker organization code?	3

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

Policy contract number

GUG0AZWH

Policy instance

Insurance contract or identification number	GUG0AZWH
Number of Individuals Covered	96
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $1,182
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,182
Insurance broker organization code?	3

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

Policy contract number

GLUG0AZWH

Policy instance

Insurance contract or identification number	GLUG0AZWH
Number of Individuals Covered	96
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $517
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $517
Insurance broker organization code?	3

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

Policy contract number

GVTL0AZWH

Policy instance

Insurance contract or identification number	GVTL0AZWH
Number of Individuals Covered	53
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $4,096
Total amount of fees paid to insurance company	USD $1,365
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $27,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,096
Insurance broker organization code?	3
Amount paid for insurance broker fees	1365

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

Policy contract number

GUG0AZWH

Policy instance

Insurance contract or identification number	GUG0AZWH
Number of Individuals Covered	118
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $1,396
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,093
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

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

Policy contract number

GLUG0AZWH

Policy instance

Insurance contract or identification number	GLUG0AZWH
Number of Individuals Covered	118
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $610
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $479
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

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

Policy contract number

GUPR0AZWH

Policy instance

Insurance contract or identification number	GUPR0AZWH
Number of Individuals Covered	34
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $1,842
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,580
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

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

Policy contract number

GLTD0AZWH

Policy instance

Insurance contract or identification number	GLTD0AZWH
Number of Individuals Covered	26
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $439
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $362
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

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

Policy contract number

GVTL0AZWH

Policy instance

Insurance contract or identification number	GVTL0AZWH
Number of Individuals Covered	62
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $4,820
Total amount of fees paid to insurance company	USD $1,607
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,012
Insurance broker organization code?	3
Amount paid for insurance broker fees	1607
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	117
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $600
Total amount of fees paid to insurance company	USD $180
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $600
Amount paid for insurance broker fees	180
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	19
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $624
Total amount of fees paid to insurance company	USD $125
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $624
Amount paid for insurance broker fees	125
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	110
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $975
Total amount of fees paid to insurance company	USD $306
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $975
Amount paid for insurance broker fees	306
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	55
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $2,808
Total amount of fees paid to insurance company	USD $562
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,808
Amount paid for insurance broker fees	562
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	27
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $1,282
Total amount of fees paid to insurance company	USD $257
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,282
Amount paid for insurance broker fees	257
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	117
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $49
Total amount of fees paid to insurance company	USD $15
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49
Amount paid for insurance broker fees	15
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	54
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $219
Total amount of fees paid to insurance company	USD $44
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $219
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	28
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $787
Total amount of fees paid to insurance company	USD $157
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $787
Amount paid for insurance broker fees	157
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	28
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $57
Total amount of fees paid to insurance company	USD $11
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	32
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $62
Total amount of fees paid to insurance company	USD $12
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 $413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	33
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $750
Total amount of fees paid to insurance company	USD $150
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 $4,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $750
Amount paid for insurance broker fees	150
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	65
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $233
Total amount of fees paid to insurance company	USD $47
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 $1,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $233
Amount paid for insurance broker fees	47
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	114
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $48
Total amount of fees paid to insurance company	USD $15
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 $482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48
Amount paid for insurance broker fees	15
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	114
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $587
Total amount of fees paid to insurance company	USD $438
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 $5,874
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
Amount paid for insurance broker fees	438
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	21
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $635
Total amount of fees paid to insurance company	USD $127
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 $4,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $635
Amount paid for insurance broker fees	127
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	113
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $993
Total amount of fees paid to insurance company	USD $914
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $993
Amount paid for insurance broker fees	914
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	67
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $2,606
Total amount of fees paid to insurance company	USD $1,280
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 $17,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,606
Amount paid for insurance broker fees	1280
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	32
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $1,333
Total amount of fees paid to insurance company	USD $820
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 $8,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,333
Amount paid for insurance broker fees	820
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	25
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $741
Total amount of fees paid to insurance company	USD $781
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 $4,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $741
Amount paid for insurance broker fees	781
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	127
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $664
Total amount of fees paid to insurance company	USD $490
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 $6,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $664
Amount paid for insurance broker fees	490
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	126
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $1,109
Total amount of fees paid to insurance company	USD $348
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,109
Amount paid for insurance broker fees	348
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	73
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $2,686
Total amount of fees paid to insurance company	USD $1,547
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 $17,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,686
Amount paid for insurance broker fees	1547
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	127
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $16
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 $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 $54
Amount paid for insurance broker fees	16
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	71
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $260
Total amount of fees paid to insurance company	USD $52
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 $1,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $260
Amount paid for insurance broker fees	52
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	34
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $69
Total amount of fees paid to insurance company	USD $14
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 $460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	35
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $812
Total amount of fees paid to insurance company	USD $162
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 $5,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $812
Amount paid for insurance broker fees	162
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00612548

Policy instance

Insurance contract or identification number	G00612548
Number of Individuals Covered	32
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $1,230
Total amount of fees paid to insurance company	USD $621
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 $8,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,230
Amount paid for insurance broker fees	621
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAYNE FINANCIAL INC

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

Policy contract number

5462719

Policy instance

Insurance contract or identification number	5462719
Number of Individuals Covered	36
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $716
Total amount of fees paid to insurance company	USD $172
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 $4,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $716
Amount paid for insurance broker fees	172
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

4053222

Policy instance

Insurance contract or identification number	4053222
Number of Individuals Covered	22
Insurance policy start date	2012-06-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $872
Total amount of fees paid to insurance company	USD $182
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	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $2,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $408
Amount paid for insurance broker fees	182
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	SOMERSET BENEFITS LLC

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

Policy contract number

4053222

Policy instance

Insurance contract or identification number	4053222
Number of Individuals Covered	61
Insurance policy start date	2012-06-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $2,484
Total amount of fees paid to insurance company	USD $422
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	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $5,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,177
Amount paid for insurance broker fees	422
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	SOMERSET BENEFITS LLC

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

Policy contract number

5462719

Policy instance

Insurance contract or identification number	5462719
Number of Individuals Covered	84
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $4,513
Total amount of fees paid to insurance company	USD $770
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 $25,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,513
Amount paid for insurance broker fees	770
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

5462719

Policy instance

Insurance contract or identification number	5462719
Number of Individuals Covered	155
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $1,186
Total amount of fees paid to insurance company	USD $362
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,186
Amount paid for insurance broker fees	362
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

5462719

Policy instance

Insurance contract or identification number	5462719
Number of Individuals Covered	28
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $154
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 $5,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	154
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

5462719

Policy instance

Insurance contract or identification number	5462719
Number of Individuals Covered	155
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $241
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 $8,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	241
Additional information about fees paid to insurance broker	PRODUCER BONUS PROGRAM
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $216
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 $4,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	28
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $392
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 $4,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	116
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $54
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 $1,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	116
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $308
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 $6,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	116
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $1,269
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	38
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $52
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 $1,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	55
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $765
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	55
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $1,044
Total amount of fees paid to insurance company	USD $45
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 $21,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	116
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $872
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $12
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 $247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $13
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 $286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	61
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $830
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $830
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	43
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $58
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 $1,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $227
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 $4,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $227
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	13
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $950
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	133
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $1,339
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,339
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	133
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $317
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 $6,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $317
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	133
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $60
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 $1,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	31
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $380
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 $4,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $380
Insurance broker organization code?	3
Insurance broker name	HEALTHFIRST BENEFITS INC

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

Policy contract number

59469

Policy instance

Insurance contract or identification number	59469
Number of Individuals Covered	61
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $1,129
Total amount of fees paid to insurance company	USD $53
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 $23,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,129
Insurance broker organization code?	3
Amount paid for insurance broker fees	53
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION
Insurance broker name	AXA ASSISTANCE USA

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Company Name:	DAVID J THOMPSON MAILING CORPORATION
Employer identification number (EIN):	112069062
NAIC Classification:	323100