WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	WELFARE BENEFIT PLAN
Plan identification number	501

WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

VORYS, SATER, SEYMOUR AND PEASE LLP has sponsored the creation of one or more 401k plans.

Company Name:	VORYS, SATER, SEYMOUR AND PEASE LLP
Employer identification number (EIN):	314333125
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers

Additional information about VORYS, SATER, SEYMOUR AND PEASE LLP

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1997-12-19
Company Identification Number:	GL344
Legal Registered Office Address:	52 EAST GAY STREET - COLUMBUS United States of America (USA) 43215

More information about VORYS, SATER, SEYMOUR AND PEASE LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELFARE BENEFIT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	ANTHONY C. CIRIACO, PARTNER	2024-02-21
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2018-10-15
501	2016-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2017-10-12
501	2015-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2016-10-12
501	2014-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2015-10-14
501	2013-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2014-10-13
501	2012-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2013-10-10
501	2011-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2012-10-08
501	2009-01-01	ANTHONY C. CIRIACO, PARTNER		ANTHONY C. CIRIACO, TRUSTEE	2010-09-15

Plan Statistics for WELFARE BENEFIT PLAN

401k plan membership statisitcs for WELFARE BENEFIT PLAN

Measure	Date	Value
2023: WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	686
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	0
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	0
2022: WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	671
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	702
Number of retired or separated participants receiving benefits	2022-01-01	12
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	714
2021: WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	642
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	664
Number of retired or separated participants receiving benefits	2021-01-01	12
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	676
2020: WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	668
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	608
Number of retired or separated participants receiving benefits	2020-01-01	11
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	619
2019: WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	678
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	669
Number of retired or separated participants receiving benefits	2019-01-01	12
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	681
2018: WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	645
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	670
Number of retired or separated participants receiving benefits	2018-01-01	8
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	678
2017: WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	635
Number of retired or separated participants receiving benefits	2017-01-01	10
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	645
2016: WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	649
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	637
Number of retired or separated participants receiving benefits	2016-01-01	15
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	652
2015: WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	683
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	655
Number of retired or separated participants receiving benefits	2015-01-01	13
Number of other retired or separated participants entitled to future benefits	2015-01-01	6
Total of all active and inactive participants	2015-01-01	674
2014: WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	684
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	660
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	660
2013: WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	713
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	676
Number of retired or separated participants receiving benefits	2013-01-01	12
Total of all active and inactive participants	2013-01-01	688
2012: WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	707
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	703
Number of retired or separated participants receiving benefits	2012-01-01	10
Total of all active and inactive participants	2012-01-01	713
2011: WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	729
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	696
Number of retired or separated participants receiving benefits	2011-01-01	9
Number of other retired or separated participants entitled to future benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	707
2009: WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	824
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	710
Number of retired or separated participants receiving benefits	2009-01-01	10
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	724

Form 5500 Responses for WELFARE BENEFIT PLAN

2023: WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	Yes
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT 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: WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	5
Insurance contract or identification number 157971 Number of Individuals Covered 154 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $8,436 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $73,694 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 689 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $1,092 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $88,423 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490-0002
Policy instance	2
Insurance contract or identification number 581490-0002 Number of Individuals Covered 462 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $6,108 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $40,723 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	3
Insurance contract or identification number 120911 Number of Individuals Covered 41 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $1,332 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $23,164 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	4
Insurance contract or identification number 120910 Number of Individuals Covered 30 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $671 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $11,253 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490-0999
Policy instance	13
Insurance contract or identification number 581490-0999 Number of Individuals Covered 1 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $54 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP INDIVIDUAL LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $692 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	6
Insurance contract or identification number 157972 Number of Individuals Covered 27 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $2,629 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,853 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	7
Insurance contract or identification number 0000160455 Number of Individuals Covered 17 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $1,722 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $10,985 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490-0800
Policy instance	12
Insurance contract or identification number 581490-0800 Number of Individuals Covered 1 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $6,793 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $52,071 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490-0004
Policy instance	11
Insurance contract or identification number 581490-0004 Number of Individuals Covered 5 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $136 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided GROUP LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $906 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	10
Insurance contract or identification number 703278 Number of Individuals Covered 303 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $9,885 Total amount of fees paid to insurance company USD $1,236 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $98,915 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	9
Insurance contract or identification number 703277 Number of Individuals Covered 684 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $9,344 Total amount of fees paid to insurance company USD $1,669 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $133,566 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	8
Insurance contract or identification number 0000153515 Number of Individuals Covered 20 Insurance policy start date 2023-01-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $1,206 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $6,688 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 687 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of fees paid to insurance company USD $2,941 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $235,649 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 2941 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 936 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $43,719 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $306,409 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43,719 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	3
Insurance contract or identification number 120911 Number of Individuals Covered 41 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,524 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $54,616 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,385 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	4
Insurance contract or identification number 120910 Number of Individuals Covered 32 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,964 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,653 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,303 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	5
Insurance contract or identification number 157971 Number of Individuals Covered 154 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $23,907 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $164,383 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,972 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	6
Insurance contract or identification number 157972 Number of Individuals Covered 23 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,026 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,120 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,678 Additional information about fees paid to insurance broker LONG TERM DISABILITY
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	8
Insurance contract or identification number 0000153515 Number of Individuals Covered 25 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $7,433 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,986 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,433 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	9
Insurance contract or identification number 703277 Number of Individuals Covered 667 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $21,499 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $260,643 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,499 Additional information about fees paid to insurance broker LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	10
Insurance contract or identification number 703278 Number of Individuals Covered 295 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $25,616 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $227,702 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,616 Additional information about fees paid to insurance broker LIFESTYLE LIFE Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	7
Insurance contract or identification number 0000160455 Number of Individuals Covered 17 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $10,505 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $24,539 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,483 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	4
Insurance contract or identification number 120910 Number of Individuals Covered 34 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $2,083 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $32,831 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,343 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	3
Insurance contract or identification number 120911 Number of Individuals Covered 45 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $3,899 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $61,454 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,597 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 865 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $40,450 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $271,435 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $40,450 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	9
Insurance contract or identification number 703277 Number of Individuals Covered 627 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $18,082 Total amount of fees paid to insurance company USD $3,229 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $258,311 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,082 Amount paid for insurance broker fees 3229 Additional information about fees paid to insurance broker LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	5
Insurance contract or identification number 157971 Number of Individuals Covered 153 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $13,932 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $179,325 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,932 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	6
Insurance contract or identification number 157972 Number of Individuals Covered 20 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $3,042 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,109 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,042 Additional information about fees paid to insurance broker LONG TERM DISABILITY
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	7
Insurance contract or identification number 0000160455 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 $1,903 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,349 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,903 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	8
Insurance contract or identification number 0000153515 Number of Individuals Covered 21 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $1,092 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,108 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,092 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	10
Insurance contract or identification number 703278 Number of Individuals Covered 248 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $21,519 Total amount of fees paid to insurance company USD $2,690 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $215,195 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,519 Amount paid for insurance broker fees 2690 Additional information about fees paid to insurance broker LIFESTYLE LIFE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 645 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of fees paid to insurance company USD $2,933 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $234,663 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 2933 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	4
Insurance contract or identification number 120910 Number of Individuals Covered 46 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $3,729 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $44,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,266 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	3
Insurance contract or identification number 120911 Number of Individuals Covered 46 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $5,485 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $64,889 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,585 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 838 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $40,241 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $249,434 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $40,241 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 612 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of fees paid to insurance company USD $3,376 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $233,293 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 3376 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	5
Insurance contract or identification number 157971 Number of Individuals Covered 156 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $14,462 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $200,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,462 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	6
Insurance contract or identification number 157972 Number of Individuals Covered 18 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $2,929 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,587 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,929 Additional information about fees paid to insurance broker LONG TERM DISABILITY
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	7
Insurance contract or identification number 0000160455 Number of Individuals Covered 5 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,398 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,892 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,398 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	8
Insurance contract or identification number 0000153515 Number of Individuals Covered 6 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $943 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,431 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $943 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	9
Insurance contract or identification number 703277 Number of Individuals Covered 602 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $16,685 Total amount of fees paid to insurance company USD $2,980 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $240,319 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,685 Amount paid for insurance broker fees 2980 Additional information about fees paid to insurance broker LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	10
Insurance contract or identification number 703278 Number of Individuals Covered 220 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $19,820 Total amount of fees paid to insurance company USD $2,478 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $214,199 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,820 Amount paid for insurance broker fees 2478 Additional information about fees paid to insurance broker LIFESTYLE LIFE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	9
Insurance contract or identification number 703277 Number of Individuals Covered 658 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $15,265 Total amount of fees paid to insurance company USD $4,956 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $238,136 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,265 Amount paid for insurance broker fees 4956 Additional information about fees paid to insurance broker LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	8
Insurance contract or identification number 0000153515 Number of Individuals Covered 15 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,602 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,001 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,602 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	7
Insurance contract or identification number 0000160455 Number of Individuals Covered 7 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,342 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,035 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 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	6
Insurance contract or identification number 157972 Number of Individuals Covered 15 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,900 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,564 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,900 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	5
Insurance contract or identification number 157971 Number of Individuals Covered 151 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $13,543 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $173,745 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,543 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	4
Insurance contract or identification number 120910 Number of Individuals Covered 49 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $4,935 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $40,571 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,113 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 674 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $216,761 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	10
Insurance contract or identification number 703278 Number of Individuals Covered 245 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $16,330 Total amount of fees paid to insurance company USD $3,669 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $179,937 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,330 Amount paid for insurance broker fees 3669 Additional information about fees paid to insurance broker LIFESTYLE LIFE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 858 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $31,214 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $221,625 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $31,214 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	3
Insurance contract or identification number 120911 Number of Individuals Covered 47 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,012 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $62,028 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,521 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703278
Policy instance	13
Insurance contract or identification number 703278 Number of Individuals Covered 230 Insurance policy start date 2018-10-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $4,433 Total amount of fees paid to insurance company USD $1,108 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $44,335 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,433 Amount paid for insurance broker fees 1108 Additional information about fees paid to insurance broker LIFESTYLE LIFE Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	703277
Policy instance	12
Insurance contract or identification number 703277 Number of Individuals Covered 636 Insurance policy start date 2018-10-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $4,156 Total amount of fees paid to insurance company USD $1,484 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $59,377 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,156 Amount paid for insurance broker fees 1484 Additional information about fees paid to insurance broker LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	11
Insurance contract or identification number 0000153515 Number of Individuals Covered 17 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $3,359 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,990 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,359 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	9
Insurance contract or identification number 157972 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 $2,399 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,239 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,964 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	5
Insurance contract or identification number OK965058 Number of Individuals Covered 629 Insurance policy start date 2018-01-01 Insurance policy end date 2018-09-30 Total amount of commissions paid to insurance broker USD $1,907 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $27,240 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,907 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	7
Insurance contract or identification number 120910 Number of Individuals Covered 57 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $3,859 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $45,066 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,289 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	6
Insurance contract or identification number 120911 Number of Individuals Covered 48 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $6,782 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $70,504 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,485 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 651 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $225,734 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 670 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $16,691 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $111,266 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,691 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	3
Insurance contract or identification number FLX963415 Number of Individuals Covered 629 Insurance policy start date 2018-01-01 Insurance policy end date 2018-09-30 Total amount of commissions paid to insurance broker USD $14,614 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $208,768 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,614 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	4
Insurance contract or identification number FLX963416 Number of Individuals Covered 232 Insurance policy start date 2018-01-01 Insurance policy end date 2018-09-30 Total amount of commissions paid to insurance broker USD $15,915 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $159,152 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,915 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	10
Insurance contract or identification number 0000160455 Number of Individuals Covered 6 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,108 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,957 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,056 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	8
Insurance contract or identification number 157971 Number of Individuals Covered 154 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $29,565 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $193,993 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,507 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 646 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $233,028 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 415 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $25,346 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $168,202 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,346 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3 Insurance broker name AON CONSULTING
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	3
Insurance contract or identification number FLX963415 Number of Individuals Covered 635 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $16,487 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $235,526 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,487 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	4
Insurance contract or identification number FLX963416 Number of Individuals Covered 240 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $20,217 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $202,168 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,217 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	5
Insurance contract or identification number OK965058 Number of Individuals Covered 635 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,284 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $32,626 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,284 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3 Insurance broker name AON CONSULTING
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	6
Insurance contract or identification number 120911 Number of Individuals Covered 52 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $8,359 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,581 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,805 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	7
Insurance contract or identification number 120910 Number of Individuals Covered 60 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $3,646 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $46,505 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,476 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	8
Insurance contract or identification number 157971 Number of Individuals Covered 152 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $37,781 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $200,193 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,453 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	9
Insurance contract or identification number 157972 Number of Individuals Covered 12 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,598 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,815 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,835 Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	10
Insurance contract or identification number 0000160455 Number of Individuals Covered 5 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,602 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,158 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,540 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO INC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	11
Insurance contract or identification number 0000153515 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 $2,495 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,497 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,495 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000153515
Policy instance	11
Insurance contract or identification number 0000153515 Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,543 Welfare Benefit Premiums Paid to Carrier USD $2,688 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,543 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	4
Insurance contract or identification number FLX963416 Number of Individuals Covered 265 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $21,086 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $210,859 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,086 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	3
Insurance contract or identification number FLX963415 Number of Individuals Covered 661 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $15,414 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $220,197 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,414 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 671 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $309,106 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker LONG TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0000160455
Policy instance	10
Insurance contract or identification number 0000160455 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 $1,341 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,403 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,341 Additional information about fees paid to insurance broker DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	9
Insurance contract or identification number 157972 Number of Individuals Covered 8 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $1,631 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,114 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,209 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	8
Insurance contract or identification number 157971 Number of Individuals Covered 162 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $37,890 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $198,425 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,832 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	7
Insurance contract or identification number 120910 Number of Individuals Covered 72 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $3,955 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $55,897 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 Additional information about fees paid to insurance broker LONG-TERM DISABIILTY Insurance broker organization code? 3 Insurance broker name ROBERT A STEWART JR.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	6
Insurance contract or identification number 120911 Number of Individuals Covered 66 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $4,871 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $77,459 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $735 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name ROBERT A STEWART JR.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	5
Insurance contract or identification number OK965058 Number of Individuals Covered 661 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,327 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $33,236 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,327 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3 Insurance broker name AON CONSULTING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 677 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $24,466 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $165,576 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,466 Additional information about fees paid to insurance broker LONG TERM CARE Insurance broker organization code? 3 Insurance broker name AON CONSULTING
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	9
Insurance contract or identification number 157972 Number of Individuals Covered 9 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $1,011 Total amount of fees paid to insurance company USD $27 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,835 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,011 Amount paid for insurance broker fees 27 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	8
Insurance contract or identification number 157971 Number of Individuals Covered 162 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $35,257 Total amount of fees paid to insurance company USD $688 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $201,713 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $35,091 Amount paid for insurance broker fees 688 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	7
Insurance contract or identification number 120910 Number of Individuals Covered 85 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $5,912 Total amount of fees paid to insurance company USD $305 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $62,042 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,179 Amount paid for insurance broker fees 305 Additional information about fees paid to insurance broker LONG-TERM DISABIILTY Insurance broker organization code? 3 Insurance broker name ROBERT A STEWART JR.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	6
Insurance contract or identification number 120911 Number of Individuals Covered 73 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $8,025 Total amount of fees paid to insurance company USD $466 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $90,872 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,783 Amount paid for insurance broker fees 466 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name ROBERT A STEWART JR.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	4
Insurance contract or identification number FLX963416 Number of Individuals Covered 265 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $27,252 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $252,693 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,463 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	3
Insurance contract or identification number FLX963415 Number of Individuals Covered 661 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $17,629 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $233,849 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,055 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name AON CONSULTING INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 674 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $24,577 Total amount of fees paid to insurance company USD $1,185 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $164,980 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,213 Amount paid for insurance broker fees 1185 Additional information about fees paid to insurance broker LONG TERM CARE 3 Insurance broker organization code? 3 Insurance broker name AON CONSULTING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 672 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of fees paid to insurance company USD $1,903 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $306,202 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 1903 Additional information about fees paid to insurance broker LONG TERM DISABILITY 3 Insurance broker name WILLIS OF OHIO, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	5
Insurance contract or identification number OK965058 Number of Individuals Covered 661 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,714 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $35,997 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,547 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3 Insurance broker name AON CONSULTING
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	6
Insurance contract or identification number 120911 Number of Individuals Covered 70 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $6,764 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $84,497 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,241 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	3
Insurance contract or identification number FLX963415 Number of Individuals Covered 676 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,683 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $209,763 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,683 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	8
Insurance contract or identification number 157971 Number of Individuals Covered 154 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $79,945 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $194,478 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $72,943 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF TENNESSEE INC - HQ
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	9
Insurance contract or identification number 157972 Number of Individuals Covered 8 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $3,022 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,994 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,823 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF TENNESSEE INC. - HQ
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	4
Insurance contract or identification number FLX963416 Number of Individuals Covered 275 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $22,318 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $223,181 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,318 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 695 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $24,814 Total amount of fees paid to insurance company USD $2,068 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $166,461 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,814 Amount paid for insurance broker fees 2068 Additional information about fees paid to insurance broker LONG TERM CARE 3 Insurance broker name WILLIS OF OHIO
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 694 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of fees paid to insurance company USD $3,735 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $370,006 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 3735 Additional information about fees paid to insurance broker LONG TERM DISABILITY 3 Insurance broker name WILLIS OF OHIO, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	7
Insurance contract or identification number 120910 Number of Individuals Covered 98 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $6,137 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $67,655 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,604 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	5
Insurance contract or identification number OK965058 Number of Individuals Covered 675 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $2,258 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $32,250 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,258 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120910
Policy instance	8
Insurance contract or identification number 120910 Number of Individuals Covered 99 Insurance policy start date 2012-10-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,237 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $69,566 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,237 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name ROBERT STEWART
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157972
Policy instance	10
Insurance contract or identification number 157972 Number of Individuals Covered 5 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $811 Total amount of fees paid to insurance company USD $90 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,822 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $811 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Amount paid for insurance broker fees 90 Insurance broker name WILLIS OF TENNESSEE INC. - HQ
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	120911
Policy instance	7
Insurance contract or identification number 120911 Number of Individuals Covered 70 Insurance policy start date 2012-10-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $7,034 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $88,826 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,034 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Insurance broker name ROBERT STEWART
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	5
Insurance contract or identification number FLX963416 Number of Individuals Covered 279 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $22,379 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $223,785 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,379 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	6
Insurance contract or identification number OK965058 Number of Individuals Covered 685 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $771 Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $11,016 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $771 Additional information about fees paid to insurance broker ACCIDENTAL DEATH & DISMEMBERMENT Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	4
Insurance contract or identification number FLX963415 Number of Individuals Covered 685 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $14,628 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $208,970 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,628 Additional information about fees paid to insurance broker LIFE INSURANCE Insurance broker organization code? 3 Insurance broker name WILLIS OF OHIO
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number	8688670
Policy instance	3
Insurance contract or identification number 8688670 Number of Individuals Covered 156 Insurance policy start date 2012-01-01 Insurance policy end date 2012-09-30 Total amount of commissions paid to insurance broker USD $32,402 Total amount of fees paid to insurance company USD $1,186 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $184,563 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,609 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Amount paid for insurance broker fees 1186 Insurance broker name JOHN MADDRILL IV
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 695 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $24,937 Total amount of fees paid to insurance company USD $2,078 Other welfare benefits provided LONG-TERM CARE Welfare Benefit Premiums Paid to Carrier USD $167,865 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,937 Amount paid for insurance broker fees 2078 Additional information about fees paid to insurance broker LONG TERM CARE 3 Insurance broker name WILLIS OF OHIO
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 688 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of fees paid to insurance company USD $3,770 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $303,133 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 3770 Additional information about fees paid to insurance broker LONG TERM DISABILITY 3 Insurance broker name WILLIS OF OHIO, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	157971
Policy instance	9
Insurance contract or identification number 157971 Number of Individuals Covered 157 Insurance policy start date 2012-10-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $23,043 Total amount of fees paid to insurance company USD $2,560 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $51,845 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,043 Additional information about fees paid to insurance broker LONG-TERM DISABILITY Insurance broker organization code? 3 Amount paid for insurance broker fees 2560 Insurance broker name WILLIS OF TENNESSEE INC - HQ
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	5
Insurance contract or identification number FLX963416 Number of Individuals Covered 494 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $16,521 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $167,796 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	1
Insurance contract or identification number 561976 Number of Individuals Covered 702 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of fees paid to insurance company USD $3,185 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $306,767 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	6
Insurance contract or identification number OK965058 Number of Individuals Covered 269 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $427 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,257 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	2
Insurance contract or identification number 581490 Number of Individuals Covered 705 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $27,091 Total amount of fees paid to insurance company USD $1,768 Other welfare benefits provided LONGTERM CARE Welfare Benefit Premiums Paid to Carrier USD $167,799 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number	8688670
Policy instance	3
Insurance contract or identification number 8688670 Number of Individuals Covered 158 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $39,040 Total amount of fees paid to insurance company USD $10,346 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $229,924 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	4
Insurance contract or identification number FLX963415 Number of Individuals Covered 694 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $10,625 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $155,889 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	065161
Policy instance	1
Insurance contract or identification number 065161 Number of Individuals Covered 696 Insurance policy start date 2010-01-01 Insurance policy end date 2010-02-28 Total amount of commissions paid to insurance broker USD $3,352 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $67,034 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963416
Policy instance	6
Insurance contract or identification number FLX963416 Number of Individuals Covered 201 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $13,405 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $131,464 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX963415
Policy instance	5
Insurance contract or identification number FLX963415 Number of Individuals Covered 715 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $10,441 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $145,063 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number	8688670
Policy instance	4
Insurance contract or identification number 8688670 Number of Individuals Covered 127 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $46,602 Total amount of fees paid to insurance company USD $79,292 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $192,582 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	581490
Policy instance	3
Insurance contract or identification number 581490 Number of Individuals Covered 714 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $24,261 Other welfare benefits provided LONGTERM CARE Welfare Benefit Premiums Paid to Carrier USD $163,135 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	561976
Policy instance	2
Insurance contract or identification number 561976 Number of Individuals Covered 717 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $305,325 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK965058
Policy instance	7
Insurance contract or identification number OK965058 Number of Individuals Covered 509 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $411 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,709 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JAVEN CONSTRUCTION CO., INC. [EIN = 161177303]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ROSEMAR CONSTRUCTION, INC. [EIN = 112895967]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF F.G. RAYBURN MASON CONTRACTORS, INC. [EIN = 161363162]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RANDSCO PIPELINE, INC. [EIN = 161160897]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF THEATRICAL SERVICES AND SUPPLIES, INC. [EIN = 112196418]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ANNSEAL, INC. [EIN = 030435899]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BON-TON OF SYRACUSE, INC. [EIN = 161131435]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF THE CONSOLIDATED BUILDING CONTRACTORS [EIN = 800441228]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF OCCHINO CORP [EIN = 160835935]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF DON TANGUAY, INC. [EIN = 481285288]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RILEY EXCAVATING & CONTRACTING, INC. [EIN = 112648930]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF MACEDON EXCAVATING AND PAVING, INC. [EIN = 161008036]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF ALLTEK ENERGY SYSTEMS, INC. [EIN = 141620911]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF C.O. FALTER CONSTRUCTION CORP [EIN = 160968314]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF TERSAL CONSTRUCTION SERVICES, INC. [EIN = 161439733]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF TOWER ROOFING COMPANY, INC. [EIN = 161566753]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF INTER CONNECTION ELECTRIC, INC. [EIN = 113027956]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ALEXSCOE, LLC DBA ATLAS FENCE [EIN = 454182606]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LAKESTONE DEVELOPMENT, INC. [EIN = 161597003]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF AB CONSTRUCTION AND ROOFING INC. [EIN = 161492423]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EMPIRE STATE MERIT APPRENTICESHIP ALLIANCE, INC. [EIN = 208482142]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LUCK BROTHERS, INC. [EIN = 141509121]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF SJ HOERNING CONSTRUCTION, INC. [EIN = 113452378]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ORCHARD EARTH & PIPE CORP. [EIN = 161140507]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF AAA CARTING & RUBBISH REMOVAL, INC. [EIN = 134068572]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RELLE ELECTRIC CORP., INC. [EIN = 113510841]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF REAL DEPENDABLE CONTRACTING CORP. [EIN = 113637290]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HYNES CONCRETE CONTRACTOR, INC. [EIN = 161085101]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JC INSULATION SERVICES, INC. [EIN = 454002788]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF GALLO CONSTRUCTION CORPORATION [EIN = 141454116]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HR ENVIRONMENTAL CONTRACTING, INC. [EIN = 264055723]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RYMAR ELECTRIC [EIN = 271418221]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CONCEPT CONSTRUCTION CORPORATION [EIN = 161469309]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF GDH CONSTRUCTION, INC. [EIN = 161181096]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ATLAS FENCE, INC. [EIN = 161121614]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHERN GLASS CO., INC. [EIN = 161134337]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EMPIRE INSULATION SPECIALTIES, INC. [EIN = 141787956]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ENVIRONMENTAL CONSTRUCTION GROUP [EIN = 203796829]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF SEAWAY EARTH & PIPE, LLC [EIN = 273635043]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF COPELAND COATING, CO., INC. [EIN = 141562182]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF FEHER RUBBISH REMOVAL, INC. [EIN = 161123509]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HAN-TEK, INC. [EIN = 161155127]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MEYER CONTRACTING CORPORATION [EIN = 141693847]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BIG ANT ELECTRIC, INC. [EIN = 113538109]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF KIMIL CONSTRUCTION, INC. [EIN = 161376982]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF A-TEAM REMEDIATION [EIN = 461126904]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF GLOBAL CONTRACTING & PAINTING, INC. [EIN = 161396911]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JD NORTHRUP CONSTRUCTION, INC. [EIN = 161024841]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF RADEC CORPORATION [EIN = 161006601]
• WELFARE BENEFITS FOR EMPLOYEES AT RICHLAND CENTER [EIN = 391017450]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY GENERAL HOSPITAL [EIN = 150622506]
• WELFARE BENEFITS - VISION [EIN = 841475486]
• WELFARE BENEFIT PLAN OF BEHAVIORAL CONNECTIONS OF WOOD CO [EIN = 341262376]
• WELFARE BENEFITS - DENTAL [EIN = 841475486]
• WELFARE BENEFITS PLAN OF SPARKS HEALTH SYSTEM [EIN = 710846701]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF PHOEBE- DEVITT HOMES [EIN = 231396838]
• WELFARE BENEFIT PROGRAMS [EIN = 411981625]
• WELFARE BENEFIT PLAN [EIN = 942147007]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF ANDERSON GROUP [EIN = 510332265]
• WELFARE BENEFIT PLAN [EIN = 952108010]
• WELFARE BENEFITS PLAN FOR HCL AMERICA EMPLOYEES [EIN = 770205035]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF PUBLIC HEALTH SOLUTIONS [EIN = 135669201]
• WELFARE BENEFIT PLAN [EIN = 581409385]
• WELFARE BENEFIT PLAN - MEDICAL [EIN = 383232737]
• WELFARE BENEFIT PLAN FOR NON-TENNESSEE EMPLOYEES [EIN = 621727563]
• WELFARE BENEFIT PLAN [EIN = 381629793]
• WELFARE BENEFIT PLAN OF CHRISTENSEN OCONNOR JOHNSON KINDNESS PLLC [EIN = 910860813]
• WELFARE BENEFIT PLAN [EIN = 362897326]
• WELFARE BENEFITS PLAN FOR CHAMPION SOLUTIONS GROUP [EIN = 592347579]
• WELFARE BENEFIT PLAN - LIF824175 [EIN = 161280696]
• WELFARE BENEFIT PLAN [EIN = 262878524]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF CONTINENTAL - RUBBER [EIN = 341417030]
• WELFARE BENEFIT PLAN [EIN = 364215970]
• WELFARE BENEFITS WRAP PLAN [EIN = 621554972]
• WELFARE BENEFIT PLAN [EIN = 430654874]
• WELFARE BENEFIT PLAN OF LEGAL ASSISTANCE OF WESTERN NEW YORK, INC. [EIN = 160955954]
• WELFARE BENEFIT PLAN [EIN = 753078675]
• WELFARE BENEFIT PLAN OF CITY UNIVERSITY [EIN = 237421224]
• WELFARE BENEFIT PROGRAM FOR RETIREES OF ARMSTRONG WORLD INDUSTRIES, INC. [EIN = 230366390]
• WELFARE BENEFIT PROGRAM FOR RETIREES OF ARMSTRONG FLOORING, INC. [EIN = 474303305]
• WELFARE BENEFITS OF UNIVERSAL INSURANCE COMPANY [EIN = 660313825]
• WELFARE BENEFIT PLAN OF NUSS TRUCK GROUP INC. [EIN = 411364452]
• WELFARE BENEFITS PROGRAM [EIN = 540969072]
• WELFARE BENEFIT PLAN [EIN = 410600750]
• WELFARE BENEFIT PROGRAM FOR EMPLOYEES OF ARMSTRONG FLOORING, INC. [EIN = 474303305]
• WELFARE BENEFIT PLAN FOR AGENTS [EIN = 350145825]
• WELFARE BENEFIT WRAP PROGRAM [EIN = 453797665]
• WELFARE BENEFIT FOR EMPLOYEES OF LAVA SCS, LLC AND DIVERSIFIED OUTSOURCE SERVICES [EIN = 270885109]
• WELFARE BENEFIT PLAN [EIN = 300802612]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF DC 37 HEALTH & SECURITY PLAN [EIN = 136209963]
• WELFARE BENEFITS PLAN [EIN = 042108376]
• WELFARE BENEFIT PLAN FOR FEEDING AMERICA EMPLOYEES [EIN = 363673599]
• WELFARE BENEFITS PLAN FOR ELIGIBLE EMPLOYEES OF THYSSEN KRUPP ACCESS [EIN = 431861064]
• WELFARE BENEFIT WRAP PROGRAM [EIN = 631047498]
• WELFARE BENEFIT WRAP PLAN [EIN = 454454484]
• WELFARE BENEFIT PLAN [EIN = 942248390]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF GARDEN CITY HOSPITAL [EIN = 381358390]
• WELFARE BENEFIT PLAN OF ORTHOPAEDIC SPECIALISTS OF THE CAROLINAS PA [EIN = 561999435]
• WELFARE BENEFIT PLAN-PRINCIPAL [EIN = 363779178]
• WELFARE BENEFIT PLAN OF LIFECORE BIOMEDICAL, LLC. [EIN = 410948334]
• WELFARE BENEFIT PLAN [EIN = 760396399]
• WELFARE BENEFIT PLAN OF TIC MAINTENANCE AND SUBSIDIARIES [EIN = 200889606]
• WELFARE BENEFIT PLAN OF SATYAM COMPUTER SERVICES [EIN = 232708334]
• WELFARE BENEFIT PLAN OF ENVIRONMENTAL FLTRATION TECHNOLOGIES LLC [EIN = 562068002]
• WELFARE BENEFIT PLAN [EIN = 953062936]
• WELFARE BENEFIT PLAN [EIN = 391877511]
• WELFARE BENEFIT PLAN [EIN = 382724516]
• WELFARE BENEFIT PLAN - LIFE INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN FOR SALARIED EMPLOYEES OF ERAMET MARIETTA, INC. [EIN = 980201165]
• WELFARE BENEFIT PLAN - DENTAL INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN - HEALTH INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN [EIN = 382756467]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF WEIR AMERICAN HYDRO CORPORATION [EIN = 232426636]
• WELFARE BENEFIT PLAN [EIN = 204011368]
• WELFARE BENEFITS TR FOR SALARY & HOURLY RETIREES OF SWEDISH MATCH [EIN = 826774663]
• WELFARE BENEFITS TR FOR UNION RETIREES OF SWEDISH MATCH [EIN = 826773585]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHERN PAVING LLC [EIN = 815298395]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF U.A. CONSTRUCTION CORPORATION [EIN = 133942105]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CRAFCO, INC. [EIN = 860324978]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHLAND ASSOCIATES, INC. [EIN = 161186414]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JDS CONSTRUCTION DIV. OF NORTHLAND ASSOCIATES, INC. [EIN = 161186414]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF POWER-UP ELECTRICAL CONTRACTING CORP. [EIN = 112793436]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NAGLE SEAL COATING, INC. [EIN = 161412023]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CALLEA ELECTRIC, INC. [EIN = 161442603]
• WELFARE BENEFIT PLAN [EIN = 840914717]
• WELFARE BENEFIT PLAN FOR SKINNER MANAGEMENT COMPANY [EIN = 593161650]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EPIC CONTRACTING, INC. [EIN = 205274868]
• WELFARE BENEFITS PLAN & TRUST [EIN = 381998421]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF DOLOMITE PRODUCTS COMPANY, INC. [EIN = 160410930]
• WELFARE BENEFIT PLAN OF ADVANCED TECHNOLOGY SERVICES INC [EIN = 371174273]
• WELFARE BENEFIT PLAN [EIN = 990282163]
• WELFARE BENEFIT PLAN [EIN = 112277818]
• WELFARE BENEFIT PLAN OF ROBINSON & COLE [EIN = 060512640]
• WELFARE BENEFIT PLAN [EIN = 382113393]
• WELFARE BENEFIT PLAN FOR EMPLOYEE OF PUBLIC HEALTH SOLUTIONS [EIN = 135669201]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF S&O CONSTRUCTION SERVICES, INC. [EIN = 141690439]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF 716 SITE CONTRACTING, INC. [EIN = 473223000]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MORSCH PIPELINE, INC.. [EIN = 453824358]
• WELFARE BENEFIT PLAN [EIN = 942176054]
• WELFARE BENEFIT PLAN [EIN = 204224643]
• WELFARE BENEFIT PLANS TRUST [EIN = 943274043]
• WELFARE BENEFIT PLAN [EIN = 593653838]
• WELFARE BENEFITS OF HR PROPERTIES INC DBA [EIN = 660601640]
• WELFARE BENEFIT PLAN [EIN = 208955304]
• WELFARE BENEFIT PLAN [EIN = 590673146]
• WELFARE BENEFIT PLAN [EIN = 392002752]
• WELFARE BENEFIT PLAN [EIN = 832134609]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CMM SITEWORK, INC. [EIN = 202744632]
• WELFARE BENEFITS [EIN = 562465023]
• WELFARE BENEFIT PLAN IAR, INC. [EIN = 202288072]
• WELFARE BENEFIT PLAN [EIN = 381996193]
• WELFARE BENEFIT PLAN [EIN = 381996193]
• WELFARE BENEFIT PLAN [EIN = 832986435]
• WELFARE BENEFIT PLAN [EIN = 030212129]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF MAINSTREAM ELECTRIC, INC. [EIN = 133802153]
• WELFARE BENEFIT PLAN [EIN = 850199988]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BENIMAX, INC. [EIN = 273269220]
• WELFARE BENEFIT PLAN [EIN = 743169328]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF SENECA STONE CORP. [EIN = 161124518]
• WELFARE BENEFITS PLAN OF GREYSTONE HEALTHCARE MANAGEMENT - MIDWEST LLC [EIN = 843875699]
• WELFARE BENEFIT OF HIAWATHA VALLEY MENTAL HEALTH CENTER [EIN = 410889423]
• WELFARE BENEFIT PLAN [EIN = 010931061]
• WELFARE BENEFIT PLAN - RETIREE HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 323232737]
• WELFARE BENEFIT PLAN [EIN = 821408778]
• WELFARE BENEFIT PLAN [EIN = 273498190]
• WELFARE BENEFIT PLAN [EIN = 860865357]
• WELFARE BENEFIT PLAN [EIN = 580623571]
• WELFARE BENEFITS PLAN OF ABLEHEARTS HEALTHCARE FOUNDATION [EIN = 204137987]
• WELFARE BENEFIT PLAN [EIN = 475138029]
• WELFARE BENEFIT PLAN - LIFE & AD&D [EIN = 475138029]
• WELFARE BENEFIT PLAN [EIN = 841307530]
• WELFARE BENEFIT PLAN [EIN = 821317953]
• WELFARE BENEFIT PLAN [EIN = 881708677]
• WELFARE BENEFIT PLANS OF PLANNED PARENTHOOD NORTH CENTRAL STATES [EIN = 830614523]
• WELFARE BENEFIT PLAN [EIN = 160775330]
• WELFARE BENEFIT PLAN BASIC GROUP AD&D [EIN = 810948786]
• WELFARE BENEFIT PLAN BASIC LIFE & SUPPLEMENTAL LIFE [EIN = 810948786]
• WELFARE BENEFIT PLAN DENTAL [EIN = 810948786]
• WELFARE BENEFIT PLAN LONG TERM DISABILITY [EIN = 810948786]
• WELFARE BENEFIT PLAN MEDICAL [EIN = 810948786]
• WELFARE BENEFIT PLAN SHORT TERM DISABILITY [EIN = 810948786]
• WELFARE BENEFIT PLAN VISION [EIN = 810948786]
• WELFARE BENEFIT PLAN [EIN = 204467006]
• WELFARE BENEFIT PLAN OF THE COOPER GROUP INC AND AFFILIATES [EIN = 850871337]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF PILON CONSTRUCTION CO., INC. [EIN = 160997428]