401k Plan data: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE plan

BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 401k Plan overview

Plan Name	BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE
Plan identification number	501

BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE Benefits

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

401k Sponsoring company profile

BAKER MANUFACTURING COMPANY LLC has sponsored the creation of one or more 401k plans.

Company Name: BAKER MANUFACTURING COMPANY LLC

Employer identification number (EIN): 204668380

NAIC Classification: 331500

Additional information about BAKER MANUFACTURING COMPANY LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4118496

More information about BAKER MANUFACTURING COMPANY LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01 DULCYANN SMITH 2023-11-14
501 2021-05-01
501 2020-05-01
501 2019-05-01
501 2018-05-01
501 2017-05-01 BECKY LARSON
501 2016-05-01 BECKY LARSON
501 2015-05-01 BECKY LARSON
501 2014-05-01 BECKY LARSON
501 2013-05-01 SANDY SAYARATH
501 2012-05-01 SANDY SAYARATH
501 2011-05-01 SANDY SAYARATH
501 2010-05-01 SANDY SAYARATH
501 2009-05-01 SANDY SAYARATH
501 2009-05-01 SANDY SAYARATH

Plan Statistics for BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE

401k plan membership statisitcs for BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE

Measure Date Value
2022: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2022 401k membership
Total participants, beginning-of-year 2022-05-01 188
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 185
Number of retired or separated participants receiving benefits 2022-05-01 1
Number of other retired or separated participants entitled to future benefits 2022-05-01 0
Total of all active and inactive participants 2022-05-01 186
Number of employers contributing to the scheme 2022-05-01 0
2021: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2021 401k membership
Total participants, beginning-of-year 2021-05-01 147
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 188
Number of retired or separated participants receiving benefits 2021-05-01 0
Number of other retired or separated participants entitled to future benefits 2021-05-01 0
Total of all active and inactive participants 2021-05-01 188
2020: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2020 401k membership
Total participants, beginning-of-year 2020-05-01 147
Total number of active participants reported on line 7a of the Form 5500 2020-05-01 147
Number of retired or separated participants receiving benefits 2020-05-01 0
Number of other retired or separated participants entitled to future benefits 2020-05-01 0
Total of all active and inactive participants 2020-05-01 147
2019: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2019 401k membership
Total participants, beginning-of-year 2019-05-01 147
Total number of active participants reported on line 7a of the Form 5500 2019-05-01 147
Number of retired or separated participants receiving benefits 2019-05-01 0
Number of other retired or separated participants entitled to future benefits 2019-05-01 0
Total of all active and inactive participants 2019-05-01 147
2018: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2018 401k membership
Total participants, beginning-of-year 2018-05-01 147
Total number of active participants reported on line 7a of the Form 5500 2018-05-01 147
Number of retired or separated participants receiving benefits 2018-05-01 0
Number of other retired or separated participants entitled to future benefits 2018-05-01 0
Total of all active and inactive participants 2018-05-01 147
2017: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2017 401k membership
Total participants, beginning-of-year 2017-05-01 180
Total number of active participants reported on line 7a of the Form 5500 2017-05-01 147
Number of retired or separated participants receiving benefits 2017-05-01 0
Number of other retired or separated participants entitled to future benefits 2017-05-01 0
Total of all active and inactive participants 2017-05-01 147
2016: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2016 401k membership
Total participants, beginning-of-year 2016-05-01 180
Total number of active participants reported on line 7a of the Form 5500 2016-05-01 180
Number of retired or separated participants receiving benefits 2016-05-01 0
Number of other retired or separated participants entitled to future benefits 2016-05-01 0
Total of all active and inactive participants 2016-05-01 180
2015: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2015 401k membership
Total participants, beginning-of-year 2015-05-01 180
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 180
Number of retired or separated participants receiving benefits 2015-05-01 0
Number of other retired or separated participants entitled to future benefits 2015-05-01 0
Total of all active and inactive participants 2015-05-01 180
2014: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2014 401k membership
Total participants, beginning-of-year 2014-05-01 180
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 180
Number of retired or separated participants receiving benefits 2014-05-01 0
Number of other retired or separated participants entitled to future benefits 2014-05-01 0
Total of all active and inactive participants 2014-05-01 180
2013: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2013 401k membership
Total participants, beginning-of-year 2013-05-01 196
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 180
Total of all active and inactive participants 2013-05-01 180
2012: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2012 401k membership
Total participants, beginning-of-year 2012-05-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 196
Total of all active and inactive participants 2012-05-01 196
2011: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2011 401k membership
Total participants, beginning-of-year 2011-05-01 112
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 123
Total of all active and inactive participants 2011-05-01 123
2010: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2010 401k membership
Total participants, beginning-of-year 2010-05-01 122
Total number of active participants reported on line 7a of the Form 5500 2010-05-01 112
Total of all active and inactive participants 2010-05-01 112
2009: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2009 401k membership
Total participants, beginning-of-year 2009-05-01 104
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 122
Total of all active and inactive participants 2009-05-01 122

Measure	Date	Value
2022: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2022 401k membership
Total participants, beginning-of-year	2022-05-01	188
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	185
Number of retired or separated participants receiving benefits	2022-05-01	1
Number of other retired or separated participants entitled to future benefits	2022-05-01	0
Total of all active and inactive participants	2022-05-01	186
Number of employers contributing to the scheme	2022-05-01	0
2021: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2021 401k membership
Total participants, beginning-of-year	2021-05-01	147
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	188
Number of retired or separated participants receiving benefits	2021-05-01	0
Number of other retired or separated participants entitled to future benefits	2021-05-01	0
Total of all active and inactive participants	2021-05-01	188
2020: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2020 401k membership
Total participants, beginning-of-year	2020-05-01	147
Total number of active participants reported on line 7a of the Form 5500	2020-05-01	147
Number of retired or separated participants receiving benefits	2020-05-01	0
Number of other retired or separated participants entitled to future benefits	2020-05-01	0
Total of all active and inactive participants	2020-05-01	147
2019: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2019 401k membership
Total participants, beginning-of-year	2019-05-01	147
Total number of active participants reported on line 7a of the Form 5500	2019-05-01	147
Number of retired or separated participants receiving benefits	2019-05-01	0
Number of other retired or separated participants entitled to future benefits	2019-05-01	0
Total of all active and inactive participants	2019-05-01	147
2018: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2018 401k membership
Total participants, beginning-of-year	2018-05-01	147
Total number of active participants reported on line 7a of the Form 5500	2018-05-01	147
Number of retired or separated participants receiving benefits	2018-05-01	0
Number of other retired or separated participants entitled to future benefits	2018-05-01	0
Total of all active and inactive participants	2018-05-01	147
2017: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2017 401k membership
Total participants, beginning-of-year	2017-05-01	180
Total number of active participants reported on line 7a of the Form 5500	2017-05-01	147
Number of retired or separated participants receiving benefits	2017-05-01	0
Number of other retired or separated participants entitled to future benefits	2017-05-01	0
Total of all active and inactive participants	2017-05-01	147
2016: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2016 401k membership
Total participants, beginning-of-year	2016-05-01	180
Total number of active participants reported on line 7a of the Form 5500	2016-05-01	180
Number of retired or separated participants receiving benefits	2016-05-01	0
Number of other retired or separated participants entitled to future benefits	2016-05-01	0
Total of all active and inactive participants	2016-05-01	180
2015: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2015 401k membership
Total participants, beginning-of-year	2015-05-01	180
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	180
Number of retired or separated participants receiving benefits	2015-05-01	0
Number of other retired or separated participants entitled to future benefits	2015-05-01	0
Total of all active and inactive participants	2015-05-01	180
2014: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2014 401k membership
Total participants, beginning-of-year	2014-05-01	180
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	180
Number of retired or separated participants receiving benefits	2014-05-01	0
Number of other retired or separated participants entitled to future benefits	2014-05-01	0
Total of all active and inactive participants	2014-05-01	180
2013: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2013 401k membership
Total participants, beginning-of-year	2013-05-01	196
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	180
Total of all active and inactive participants	2013-05-01	180
2012: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2012 401k membership
Total participants, beginning-of-year	2012-05-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	196
Total of all active and inactive participants	2012-05-01	196
2011: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2011 401k membership
Total participants, beginning-of-year	2011-05-01	112
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	123
Total of all active and inactive participants	2011-05-01	123
2010: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2010 401k membership
Total participants, beginning-of-year	2010-05-01	122
Total number of active participants reported on line 7a of the Form 5500	2010-05-01	112
Total of all active and inactive participants	2010-05-01	112
2009: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2009 401k membership
Total participants, beginning-of-year	2009-05-01	104
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	122
Total of all active and inactive participants	2009-05-01	122

Form 5500 Responses for BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE

2022: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2020 form 5500 responses
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	Plan funding arrangement – Insurance	Yes
2020-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-05-01	Plan benefit arrangement – Insurance	Yes
2020-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2019 form 5500 responses
2019-05-01	Type of plan entity	Single employer plan
2019-05-01	Plan funding arrangement – Insurance	Yes
2019-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-05-01	Plan benefit arrangement – Insurance	Yes
2019-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2018 form 5500 responses
2018-05-01	Type of plan entity	Single employer plan
2018-05-01	Plan funding arrangement – Insurance	Yes
2018-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-05-01	Plan benefit arrangement – Insurance	Yes
2018-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	Plan funding arrangement – Insurance	Yes
2017-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2017-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2016 form 5500 responses
2016-05-01	Type of plan entity	Single employer plan
2016-05-01	Plan funding arrangement – Insurance	Yes
2016-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-05-01	Plan benefit arrangement – Insurance	Yes
2016-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2015 form 5500 responses
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Plan funding arrangement – Insurance	Yes
2015-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2015-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Plan funding arrangement – Insurance	Yes
2014-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Plan funding arrangement – Insurance	Yes
2013-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Plan funding arrangement – Insurance	Yes
2012-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2012-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Plan funding arrangement – Insurance	Yes
2011-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2010 form 5500 responses
2010-05-01	Type of plan entity	Single employer plan
2010-05-01	Plan funding arrangement – Insurance	Yes
2010-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-05-01	Plan benefit arrangement – Insurance	Yes
2010-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: BAKER MANUFACTURING COMPANY LLC MEDICAL DENTAL LIFE ACCIDENTAL DEATH AND EMPLOYEE ASSISTANCE 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	Submission has been amended	Yes
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	64
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $782
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $510
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CURALINC HEALTHCARE (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	147
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

21844

Policy instance

Insurance contract or identification number	21844
Number of Individuals Covered	187
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $14,158
Total amount of fees paid to insurance company	USD $2,184
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $67,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,060
Amount paid for insurance broker fees	1674
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

195508

Policy instance

Insurance contract or identification number	195508
Number of Individuals Covered	213
Insurance policy start date	2022-05-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $4,986
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $194,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,986
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	55
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $669
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $669
Insurance broker organization code?	3

CURALINC HEALTHCARE (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	147
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

195508

Policy instance

Insurance contract or identification number	195508
Number of Individuals Covered	216
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $60,071
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,325,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,071
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00021844

Policy instance

Insurance contract or identification number	00021844
Number of Individuals Covered	188
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $9,501
Total amount of fees paid to insurance company	USD $2,429
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 $63,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,501
Amount paid for insurance broker fees	2429
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

876815

Policy instance

Insurance contract or identification number	876815
Number of Individuals Covered	46
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $1,178
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,178
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	50
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $694
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $694
Insurance broker organization code?	3

CURALINC HEALTHCARE (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	147
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

195508

Policy instance

Insurance contract or identification number	195508
Number of Individuals Covered	224
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $57,731
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,989,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,731
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	181
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $7,420
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,309
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	42
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $3,109
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,641
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

876815

Policy instance

Insurance contract or identification number	876815
Number of Individuals Covered	45
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $1,356
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,356
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	51
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $759
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $759
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

195508

Policy instance

Insurance contract or identification number	195508
Number of Individuals Covered	241
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $62,261
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,090,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,261
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	196
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $7,799
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,603
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	46
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $3,009
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,539
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

876815

Policy instance

Insurance contract or identification number	876815
Number of Individuals Covered	71
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $2,126
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,126
Insurance broker organization code?	3

CURALINC HEALTHCARE (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	147
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	194
Insurance policy start date	2018-05-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $3,391
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,391
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	51
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $654
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $654
Insurance broker organization code?	3

CURALINC HEALTHCARE (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	147
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	201
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $7,716
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,514
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	41
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $3,108
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,617
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

876815

Policy instance

Insurance contract or identification number	876815
Number of Individuals Covered	39
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $2,170
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,170
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

195508

Policy instance

Insurance contract or identification number	195508
Number of Individuals Covered	251
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $57,542
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,923,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,542
Insurance broker organization code?	3

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	222
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $39,257
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,355,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,257
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	46
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $644
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $644
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

CURALINC HEALTHCARE (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	147
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

02547815

Policy instance

Insurance contract or identification number	02547815
Number of Individuals Covered	61
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $21,129
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $546,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,129
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	189
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $7,442
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,286
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	42
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $3,481
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,954
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $323
Temporary Disability 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 $323
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

876815

Policy instance

Insurance contract or identification number	876815
Number of Individuals Covered	38
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $2,045
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,045
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

02547815

Policy instance

Insurance contract or identification number	02547815
Number of Individuals Covered	60
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $21,483
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $506,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,483
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

0876815

Policy instance

Insurance contract or identification number	0876815
Number of Individuals Covered	37
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $1,948
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,948
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	61
Insurance policy start date	2015-06-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $4,672
Temporary Disability 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 $999
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	48
Insurance policy start date	2015-06-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $3,950
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $828
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	61
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $125
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125
Insurance broker organization code?	3
Insurance broker name

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300202852

Policy instance

Insurance contract or identification number	40000300202852
Number of Individuals Covered	44
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $4
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24
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
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115368

Policy instance

Insurance contract or identification number	000010115368
Number of Individuals Covered	63
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $318
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $318
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115367

Policy instance

Insurance contract or identification number	000010115367
Number of Individuals Covered	6
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $12
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115366

Policy instance

Insurance contract or identification number	000010115366
Number of Individuals Covered	116
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $14
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $90
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
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	196
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $31,601
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,066,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,601
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	55
Insurance policy start date	2015-05-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $10
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $66
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
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	33
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $388
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $388
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

CURALINC HEALTHCARE (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	180
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159950

Policy instance

Insurance contract or identification number	159950
Number of Individuals Covered	176
Insurance policy start date	2015-06-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $7,652
Life 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 $1,642
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	206
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $30,791
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,069,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,791
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	60
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $1,441
Total amount of fees paid to insurance company	USD $72
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,441
Amount paid for insurance broker fees	72
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name

CURALINC HEALTHCARE (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	180
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115366

Policy instance

Insurance contract or identification number	000010115366
Number of Individuals Covered	115
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,858
Total amount of fees paid to insurance company	USD $217
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,858
Amount paid for insurance broker fees	217
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115368

Policy instance

Insurance contract or identification number	000010115368
Number of Individuals Covered	61
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,648
Total amount of fees paid to insurance company	USD $181
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,648
Amount paid for insurance broker fees	181
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300202852

Policy instance

Insurance contract or identification number	40000300202852
Number of Individuals Covered	42
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $2,342
Total amount of fees paid to insurance company	USD $126
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,342
Amount paid for insurance broker fees	126
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	29
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $422
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $422
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	54
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $1,569
Total amount of fees paid to insurance company	USD $90
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,569
Amount paid for insurance broker fees	90
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115367

Policy instance

Insurance contract or identification number	000010115367
Number of Individuals Covered	6
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $546
Total amount of fees paid to insurance company	USD $37
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $546
Amount paid for insurance broker fees	37
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	62
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,510
Total amount of fees paid to insurance company	USD $145
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,510
Amount paid for insurance broker fees	145
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	227
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $26,708
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $946,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,708
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	27
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $594
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $594
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	61
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,431
Total amount of fees paid to insurance company	USD $119
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,431
Amount paid for insurance broker fees	119
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300202852

Policy instance

Insurance contract or identification number	40000300202852
Number of Individuals Covered	42
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $2,181
Total amount of fees paid to insurance company	USD $180
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,181
Amount paid for insurance broker fees	180
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010115368

Policy instance

Insurance contract or identification number	000010115368
Number of Individuals Covered	62
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $3,580
Total amount of fees paid to insurance company	USD $261
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,580
Amount paid for insurance broker fees	261
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115367

Policy instance

Insurance contract or identification number	10115367
Number of Individuals Covered	8
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $564
Total amount of fees paid to insurance company	USD $50
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $564
Amount paid for insurance broker fees	50
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

CURALINC HEALTHCARE (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	180
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115366

Policy instance

Insurance contract or identification number	10115366
Number of Individuals Covered	109
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $3,349
Total amount of fees paid to insurance company	USD $330
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,349
Amount paid for insurance broker fees	330
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115368

Policy instance

Insurance contract or identification number	10115368
Number of Individuals Covered	65
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $3,518
Total amount of fees paid to insurance company	USD $449
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,518
Amount paid for insurance broker fees	449
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	70
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $1,627
Total amount of fees paid to insurance company	USD $283
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,627
Amount paid for insurance broker fees	283
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3113

Policy instance

Insurance contract or identification number	3113
Number of Individuals Covered	233
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $28,942
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $993,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,942
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	28
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $686
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $686
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300202852

Policy instance

Insurance contract or identification number	40000300202852
Number of Individuals Covered	47
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $1,987
Total amount of fees paid to insurance company	USD $408
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,987
Amount paid for insurance broker fees	408
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115366

Policy instance

Insurance contract or identification number	10115366
Number of Individuals Covered	117
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $3,893
Total amount of fees paid to insurance company	USD $613
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,893
Amount paid for insurance broker fees	613
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115367

Policy instance

Insurance contract or identification number	10115367
Number of Individuals Covered	7
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $548
Total amount of fees paid to insurance company	USD $133
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $548
Amount paid for insurance broker fees	133
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

CURALINC HEALTHCARE (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	196
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	64
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $1,486
Total amount of fees paid to insurance company	USD $259
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,486
Amount paid for insurance broker fees	259
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name

CURALINC HEALTHCARE (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	202
Insurance policy start date	2011-08-01
Insurance policy end date	2012-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	24
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $408
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115366

Policy instance

Insurance contract or identification number	10115366
Number of Individuals Covered	123
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $3,984
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115367

Policy instance

Insurance contract or identification number	10115367
Number of Individuals Covered	8
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $778
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	66
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,718
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115368

Policy instance

Insurance contract or identification number	10115368
Number of Individuals Covered	62
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $2,984
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	120
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300202852

Policy instance

Insurance contract or identification number	40000300202852
Number of Individuals Covered	48
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $2,354
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	60
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,642
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

31130-31135

Policy instance

Insurance contract or identification number	31130-31135
Number of Individuals Covered	233
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $28,260
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $953,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400115371

Policy instance

Insurance contract or identification number	000400115371
Number of Individuals Covered	56
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $1,247
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	112
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

31130-31135

Policy instance

Insurance contract or identification number	31130-31135
Number of Individuals Covered	215
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $26,423
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $908,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

698575

Policy instance

Insurance contract or identification number	698575
Number of Individuals Covered	23
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $268
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010117440

Policy instance

Insurance contract or identification number	000010117440
Number of Individuals Covered	62
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $1,500
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115368

Policy instance

Insurance contract or identification number	10115368
Number of Individuals Covered	64
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $2,523
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115366

Policy instance

Insurance contract or identification number	10115366
Number of Individuals Covered	109
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $3,452
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $20,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115367

Policy instance

Insurance contract or identification number	10115367
Number of Individuals Covered	9
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $814
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

40000300100626

Policy instance

Insurance contract or identification number	40000300100626
Number of Individuals Covered	46
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $2,035
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BAKER MANUFACTURING COMPANY LLC
Employer identification number (EIN):	204668380
NAIC Classification:	331500

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4118496

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-05-01	DULCYANN SMITH	2023-11-14
501	2021-05-01
501	2020-05-01
501	2019-05-01
501	2018-05-01
501	2017-05-01	BECKY LARSON
501	2016-05-01	BECKY LARSON
501	2015-05-01	BECKY LARSON
501	2014-05-01	BECKY LARSON
501	2013-05-01	SANDY SAYARATH
501	2012-05-01	SANDY SAYARATH
501	2011-05-01	SANDY SAYARATH
501	2010-05-01	SANDY SAYARATH
501	2009-05-01	SANDY SAYARATH
501	2009-05-01	SANDY SAYARATH