401k Plan data: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN plan

MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 401k Plan overview

Plan Name	MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN
Plan identification number	501

MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

MARCKISOTTO MARKETS INC. has sponsored the creation of one or more 401k plans.

Company Name: MARCKISOTTO MARKETS INC.

Employer identification number (EIN): 251394610

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 JORDAN MARCKISOTTO
501 2016-01-01 JORDAN MARCKISOTTO
501 2015-01-01 JORDAN MARCKISOTTO
501 2014-01-01 JORDAN MARCKISOTTO

Plan Statistics for MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN

401k plan membership statisitcs for MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN

Measure Date Value
2021: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 79
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 76
Total of all active and inactive participants 2021-01-01 76
Total participants 2021-01-01 76
2020: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 73
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 79
Total of all active and inactive participants 2020-01-01 79
Total participants 2020-01-01 79
2019: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 74
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 73
Total of all active and inactive participants 2019-01-01 73
Total participants 2019-01-01 73
2018: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 74
Total of all active and inactive participants 2018-01-01 74
Total participants 2018-01-01 74
2017: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 89
Total of all active and inactive participants 2017-01-01 89
Total participants 2017-01-01 89
2016: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 87
Total of all active and inactive participants 2016-01-01 87
Total participants 2016-01-01 87
2015: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 102
Total of all active and inactive participants 2015-01-01 102
Total participants 2015-01-01 0
2014: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 104
Total of all active and inactive participants 2014-01-01 104
Total participants 2014-01-01 0

Measure	Date	Value
2021: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	76
Total of all active and inactive participants	2021-01-01	76
Total participants	2021-01-01	76
2020: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	73
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	79
Total of all active and inactive participants	2020-01-01	79
Total participants	2020-01-01	79
2019: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	74
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	73
Total of all active and inactive participants	2019-01-01	73
Total participants	2019-01-01	73
2018: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	74
Total of all active and inactive participants	2018-01-01	74
Total participants	2018-01-01	74
2017: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	89
Total of all active and inactive participants	2017-01-01	89
Total participants	2017-01-01	89
2016: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	87
Total of all active and inactive participants	2016-01-01	87
Total participants	2016-01-01	87
2015: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	102
Total of all active and inactive participants	2015-01-01	102
Total participants	2015-01-01	0
2014: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	104
Total of all active and inactive participants	2014-01-01	104
Total participants	2014-01-01	0

Form 5500 Responses for MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN

2021: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MARCKISOTTO MARKETS INC. EMPLOYEE WELFARE BENEFIT WRAP PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679306

Policy instance

Insurance contract or identification number	004679306
Number of Individuals Covered	15
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,957
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,957

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679914

Policy instance

Insurance contract or identification number	004679914
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
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

168514

Policy instance

Insurance contract or identification number	168514
Number of Individuals Covered	76
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,046
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,046

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3920

Policy instance

Insurance contract or identification number	3920
Number of Individuals Covered	41
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $194
Total amount of fees paid to insurance company	USD $756
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 $194
Amount paid for insurance broker fees	756
Additional information about fees paid to insurance broker	ADMINSTRATIVE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679804

Policy instance

Insurance contract or identification number	004679804
Number of Individuals Covered	10
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,580
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,580

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679105

Policy instance

Insurance contract or identification number	004679105
Number of Individuals Covered	4
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,126
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,126

UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )

Policy contract number

004679CA0

Policy instance

Insurance contract or identification number	004679CA0
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61
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

UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )

Policy contract number

004679AA0

Policy instance

Insurance contract or identification number	004679AA0
Number of Individuals Covered	46
Insurance policy start date	2021-01-31
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,292
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,292

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679916

Policy instance

Insurance contract or identification number	004679916
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679917

Policy instance

Insurance contract or identification number	004679917
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679803

Policy instance

Insurance contract or identification number	004679803
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679913

Policy instance

Insurance contract or identification number	004679913
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679306

Policy instance

Insurance contract or identification number	004679306
Number of Individuals Covered	12
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,763
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,763

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	22
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $953
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 $6,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $953

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	79
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $522
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 $5,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $522

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3920

Policy instance

Insurance contract or identification number	3920
Number of Individuals Covered	40
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $173
Total amount of fees paid to insurance company	USD $449
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $173
Amount paid for insurance broker fees	449
Additional information about fees paid to insurance broker	ADMINSTRATIVE

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679916

Policy instance

Insurance contract or identification number	004679916
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )

Policy contract number

004679804

Policy instance

Insurance contract or identification number	004679804
Number of Individuals Covered	14
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,243
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,243

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679105

Policy instance

Insurance contract or identification number	004679105
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $824
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $824

UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )

Policy contract number

004679CA0

Policy instance

Insurance contract or identification number	004679CA0
Number of Individuals Covered	2
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $48
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $479
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

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679914

Policy instance

Insurance contract or identification number	004679914
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679913

Policy instance

Insurance contract or identification number	004679913
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679803

Policy instance

Insurance contract or identification number	004679803
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679917

Policy instance

Insurance contract or identification number	004679917
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )

Policy contract number

004679AA0

Policy instance

Insurance contract or identification number	004679AA0
Number of Individuals Covered	50
Insurance policy start date	2020-01-31
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,202
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,202

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679105

Policy instance

Insurance contract or identification number	004679105
Number of Individuals Covered	4
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,188
Welfare Benefit Premiums Paid to Carrier	USD $23,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,188

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679802

Policy instance

Insurance contract or identification number	004679802
Number of Individuals Covered	9
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,687
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,687

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679306

Policy instance

Insurance contract or identification number	004679306
Number of Individuals Covered	11
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,717
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,717
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	21
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $896
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 $5,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $896
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	38
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,073
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 $13,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,073
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3920

Policy instance

Insurance contract or identification number	3920
Number of Individuals Covered	36
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $163
Total amount of fees paid to insurance company	USD $423
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $163
Amount paid for insurance broker fees	423
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	73
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $521
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $521
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679105

Policy instance

Insurance contract or identification number	004679105
Number of Individuals Covered	4
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,369
Welfare Benefit Premiums Paid to Carrier	USD $21,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,369

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679802

Policy instance

Insurance contract or identification number	004679802
Number of Individuals Covered	7
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,485
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,485

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679306

Policy instance

Insurance contract or identification number	004679306
Number of Individuals Covered	12
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,604
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,604
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	74
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $589
Total amount of fees paid to insurance company	USD $354
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 $5,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $589
Amount paid for insurance broker fees	354
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	15
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $960
Total amount of fees paid to insurance company	USD $606
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 $6,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $960
Amount paid for insurance broker fees	606
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3920

Policy instance

Insurance contract or identification number	3920
Number of Individuals Covered	36
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $502
Total amount of fees paid to insurance company	USD $193
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $502
Amount paid for insurance broker fees	193
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	40
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,213
Total amount of fees paid to insurance company	USD $625
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,213
Amount paid for insurance broker fees	625
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	51
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,417
Total amount of fees paid to insurance company	USD $431
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,417
Amount paid for insurance broker fees	431
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3920

Policy instance

Insurance contract or identification number	3920
Number of Individuals Covered	47
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $218
Total amount of fees paid to insurance company	USD $567
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $218
Amount paid for insurance broker fees	567
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	25
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,516
Total amount of fees paid to insurance company	USD $561
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 $10,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,516
Amount paid for insurance broker fees	561
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	89
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $590
Total amount of fees paid to insurance company	USD $371
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 $5,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $590
Amount paid for insurance broker fees	371
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFIT SERVICES

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679306

Policy instance

Insurance contract or identification number	004679306
Number of Individuals Covered	10
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,647
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,647
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFIT SERVICES

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679802

Policy instance

Insurance contract or identification number	004679802
Number of Individuals Covered	14
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,685
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,685
Insurance broker name	STRATEGIC EMPLOYEE BENEFIT SERVICES

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

Policy contract number

Policy instance

Number of Individuals Covered	33
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $603
Total amount of fees paid to insurance company	USD $245
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $392
Amount paid for insurance broker fees	245
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LIFETIME FINANCIAL GROWTH LLC

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

Policy contract number

235666

Policy instance

Insurance contract or identification number	235666
Number of Individuals Covered	16
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $560
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 $3,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $375
Insurance broker organization code?	3
Insurance broker name	LIAZON BENEFITS INC.

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

Policy contract number

TS05344324

Policy instance

Insurance contract or identification number	TS05344324
Number of Individuals Covered	25
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,042
Total amount of fees paid to insurance company	USD $1,034
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,042
Amount paid for insurance broker fees	34
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LIAZON BENEFITS INC.

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679102

Policy instance

Insurance contract or identification number	004679102
Number of Individuals Covered	16
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,329
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,329
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679103

Policy instance

Insurance contract or identification number	004679103
Number of Individuals Covered	17
Insurance policy start date	2015-01-01
Insurance policy end date	2015-01-23
Total amount of commissions paid to insurance broker	USD $2,099
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,099
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679104

Policy instance

Insurance contract or identification number	004679104
Number of Individuals Covered	12
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,228
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,228
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679304

Policy instance

Insurance contract or identification number	004679304
Number of Individuals Covered	9
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,311
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,311
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679305

Policy instance

Insurance contract or identification number	004679305
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $152
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $152
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679909

Policy instance

Insurance contract or identification number	004679909
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $64
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $660
Total amount of fees paid to insurance company	USD $140
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 $6,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $660
Amount paid for insurance broker fees	140
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH COVERAGE (National Association of Insurance Commissioners NAIC id number: 15451 )

Policy contract number

004679911

Policy instance

Insurance contract or identification number	004679911
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $169
Welfare Benefit Premiums Paid to Carrier	USD $6,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	169
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

235666

Policy instance

Insurance contract or identification number	235666
Number of Individuals Covered	57
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $559
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 $3,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $374
Insurance broker organization code?	3
Insurance broker name	LIAZON BENEFITS INC.

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

Policy contract number

TS05344324

Policy instance

Insurance contract or identification number	TS05344324
Number of Individuals Covered	31
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,339
Total amount of fees paid to insurance company	USD $1,611
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,339
Insurance broker organization code?	3
Amount paid for insurance broker fees	1180
Additional information about fees paid to insurance broker	ADMINSTRATION FEES
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679300

Policy instance

Insurance contract or identification number	004679300
Number of Individuals Covered	30
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,701
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,701
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679301

Policy instance

Insurance contract or identification number	004679301
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,806
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,806
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679302

Policy instance

Insurance contract or identification number	004679302
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $462
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $462
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679303

Policy instance

Insurance contract or identification number	004679303
Number of Individuals Covered	4
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $483
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $483
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679800

Policy instance

Insurance contract or identification number	004679800
Number of Individuals Covered	15
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,003
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,003
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )

Policy contract number

004679801

Policy instance

Insurance contract or identification number	004679801
Number of Individuals Covered	17
Total amount of commissions paid to insurance broker	USD $3,213
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,213
Insurance broker organization code?	3
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

G000ARHU

Policy instance

Insurance contract or identification number	G000ARHU
Number of Individuals Covered	104
Total amount of commissions paid to insurance broker	USD $660
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 $6,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $660
Insurance broker name	STRATEGIC EMPLOYEE BENEFITS SERVICE

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

Policy contract number

Policy instance

Number of Individuals Covered	48
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $793
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $489
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LIFETIME FINANCIAL GROWTH LLC

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Company Name:	MARCKISOTTO MARKETS INC.
Employer identification number (EIN):	251394610
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores