401k Plan data: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN plan

THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN
Plan identification number	501

THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

THE OHIO MOULDING CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: THE OHIO MOULDING CORPORATION

Employer identification number (EIN): 340792024

NAIC Classification: 332110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 CLINTON CASSESE 2023-12-12
501 2021-06-01 CLINTON CASSESE 2022-11-23
501 2020-06-01 CLINTON CASSESE 2021-11-29
501 2019-06-01 CLINTON CASSESE 2021-01-25
501 2018-06-01 CLINTON CASSESE 2020-03-03
501 2017-06-01
501 2016-06-01
501 2015-06-01
501 2014-06-01 CLINTON CASSESE
501 2013-06-01 CLINTON CASSESE
501 2012-06-01 KATHLEEN MORAN
501 2011-06-01 CLINTON CASSESE
501 2010-06-01 CLINTON CASSESE
501 2009-06-01 CLINTON CASSESE
501 2008-06-01 CLINTON CASSESE
501 2007-06-01 CLINTON CASSESE
501 2006-06-01 CLINTON CASSESE
501 2005-06-01 CLINTON CASSESE
501 2004-06-01 CLINTON CASSESE
501 2003-06-01 CLINTON CASSESE
501 2002-06-01 CLINTON CASSESE
501 2001-06-01 CLINTON CASSESE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-06-01	CLINTON CASSESE	2023-12-12
501	2021-06-01	CLINTON CASSESE	2022-11-23
501	2020-06-01	CLINTON CASSESE	2021-11-29
501	2019-06-01	CLINTON CASSESE	2021-01-25
501	2018-06-01	CLINTON CASSESE	2020-03-03
501	2017-06-01
501	2016-06-01
501	2015-06-01
501	2014-06-01	CLINTON CASSESE
501	2013-06-01	CLINTON CASSESE
501	2012-06-01	KATHLEEN MORAN
501	2011-06-01	CLINTON CASSESE
501	2010-06-01	CLINTON CASSESE
501	2009-06-01	CLINTON CASSESE
501	2008-06-01	CLINTON CASSESE
501	2007-06-01	CLINTON CASSESE
501	2006-06-01	CLINTON CASSESE
501	2005-06-01	CLINTON CASSESE
501	2004-06-01	CLINTON CASSESE
501	2003-06-01	CLINTON CASSESE
501	2002-06-01	CLINTON CASSESE
501	2001-06-01	CLINTON CASSESE

Plan Statistics for THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 278
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 270
Number of retired or separated participants receiving benefits 2022-06-01 1
Total of all active and inactive participants 2022-06-01 271
2021: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-06-01 248
Total number of active participants reported on line 7a of the Form 5500 2021-06-01 277
Number of retired or separated participants receiving benefits 2021-06-01 1
Total of all active and inactive participants 2021-06-01 278
2020: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 256
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 246
Number of retired or separated participants receiving benefits 2020-06-01 2
Total of all active and inactive participants 2020-06-01 248
2019: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-06-01 248
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 253
Number of retired or separated participants receiving benefits 2019-06-01 3
Total of all active and inactive participants 2019-06-01 256
2018: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 255
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 248
Total of all active and inactive participants 2018-06-01 248
2017: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 299
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 252
Number of other retired or separated participants entitled to future benefits 2017-06-01 3
Total of all active and inactive participants 2017-06-01 255
2016: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 304
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 299
Total of all active and inactive participants 2016-06-01 299
2015: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 254
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 304
Total of all active and inactive participants 2015-06-01 304
2014: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 194
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 254
Total of all active and inactive participants 2014-06-01 254
2013: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 230
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 194
Total of all active and inactive participants 2013-06-01 194
2012: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 203
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 230
Total of all active and inactive participants 2012-06-01 230
2011: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 117
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 203
Total of all active and inactive participants 2011-06-01 203
2010: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-06-01 85
Total number of active participants reported on line 7a of the Form 5500 2010-06-01 117
Total of all active and inactive participants 2010-06-01 117
2009: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 77
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 85
Total of all active and inactive participants 2009-06-01 85
2008: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-06-01 121
Total number of active participants reported on line 7a of the Form 5500 2008-06-01 77
Total of all active and inactive participants 2008-06-01 77
2007: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year 2007-06-01 152
Total number of active participants reported on line 7a of the Form 5500 2007-06-01 121
Total of all active and inactive participants 2007-06-01 121
2006: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year 2006-06-01 160
Total number of active participants reported on line 7a of the Form 5500 2006-06-01 152
Total of all active and inactive participants 2006-06-01 152
2005: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year 2005-06-01 150
Total number of active participants reported on line 7a of the Form 5500 2005-06-01 160
Total of all active and inactive participants 2005-06-01 160
2004: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year 2004-06-01 133
Total number of active participants reported on line 7a of the Form 5500 2004-06-01 150
Total of all active and inactive participants 2004-06-01 150
2003: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year 2003-06-01 127
Total number of active participants reported on line 7a of the Form 5500 2003-06-01 133
Total of all active and inactive participants 2003-06-01 133
2002: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year 2002-06-01 103
Total number of active participants reported on line 7a of the Form 5500 2002-06-01 127
Total of all active and inactive participants 2002-06-01 127
2001: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2001 401k membership
Total number of active participants reported on line 7a of the Form 5500 2001-06-01 103
Total of all active and inactive participants 2001-06-01 103

Measure	Date	Value
2022: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	278
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	270
Number of retired or separated participants receiving benefits	2022-06-01	1
Total of all active and inactive participants	2022-06-01	271
2021: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	248
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	277
Number of retired or separated participants receiving benefits	2021-06-01	1
Total of all active and inactive participants	2021-06-01	278
2020: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	256
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	246
Number of retired or separated participants receiving benefits	2020-06-01	2
Total of all active and inactive participants	2020-06-01	248
2019: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	248
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	253
Number of retired or separated participants receiving benefits	2019-06-01	3
Total of all active and inactive participants	2019-06-01	256
2018: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	255
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	248
Total of all active and inactive participants	2018-06-01	248
2017: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	299
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	252
Number of other retired or separated participants entitled to future benefits	2017-06-01	3
Total of all active and inactive participants	2017-06-01	255
2016: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	304
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	299
Total of all active and inactive participants	2016-06-01	299
2015: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	254
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	304
Total of all active and inactive participants	2015-06-01	304
2014: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	194
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	254
Total of all active and inactive participants	2014-06-01	254
2013: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	230
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	194
Total of all active and inactive participants	2013-06-01	194
2012: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	203
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	230
Total of all active and inactive participants	2012-06-01	230
2011: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	117
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	203
Total of all active and inactive participants	2011-06-01	203
2010: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-06-01	85
Total number of active participants reported on line 7a of the Form 5500	2010-06-01	117
Total of all active and inactive participants	2010-06-01	117
2009: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	77
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	85
Total of all active and inactive participants	2009-06-01	85
2008: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-06-01	121
Total number of active participants reported on line 7a of the Form 5500	2008-06-01	77
Total of all active and inactive participants	2008-06-01	77
2007: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-06-01	152
Total number of active participants reported on line 7a of the Form 5500	2007-06-01	121
Total of all active and inactive participants	2007-06-01	121
2006: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-06-01	160
Total number of active participants reported on line 7a of the Form 5500	2006-06-01	152
Total of all active and inactive participants	2006-06-01	152
2005: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-06-01	150
Total number of active participants reported on line 7a of the Form 5500	2005-06-01	160
Total of all active and inactive participants	2005-06-01	160
2004: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year	2004-06-01	133
Total number of active participants reported on line 7a of the Form 5500	2004-06-01	150
Total of all active and inactive participants	2004-06-01	150
2003: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year	2003-06-01	127
Total number of active participants reported on line 7a of the Form 5500	2003-06-01	133
Total of all active and inactive participants	2003-06-01	133
2002: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year	2002-06-01	103
Total number of active participants reported on line 7a of the Form 5500	2002-06-01	127
Total of all active and inactive participants	2002-06-01	127
2001: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2001 401k membership
Total number of active participants reported on line 7a of the Form 5500	2001-06-01	103
Total of all active and inactive participants	2001-06-01	103

Form 5500 Responses for THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN

2022: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2008 form 5500 responses
2008-06-01	Type of plan entity	Single employer plan
2008-06-01	Plan funding arrangement – Insurance	Yes
2008-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-06-01	Plan benefit arrangement – Insurance	Yes
2008-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2007 form 5500 responses
2007-06-01	Type of plan entity	Single employer plan
2007-06-01	Plan funding arrangement – Insurance	Yes
2007-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-06-01	Plan benefit arrangement – Insurance	Yes
2007-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2006 form 5500 responses
2006-06-01	Type of plan entity	Single employer plan
2006-06-01	Plan funding arrangement – Insurance	Yes
2006-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-06-01	Plan benefit arrangement – Insurance	Yes
2006-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2005 form 5500 responses
2005-06-01	Type of plan entity	Single employer plan
2005-06-01	Plan funding arrangement – Insurance	Yes
2005-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-06-01	Plan benefit arrangement – Insurance	Yes
2005-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2004 form 5500 responses
2004-06-01	Type of plan entity	Single employer plan
2004-06-01	Plan funding arrangement – Insurance	Yes
2004-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-06-01	Plan benefit arrangement – Insurance	Yes
2004-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2003: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2003 form 5500 responses
2003-06-01	Type of plan entity	Single employer plan
2003-06-01	Plan funding arrangement – Insurance	Yes
2003-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2003-06-01	Plan benefit arrangement – Insurance	Yes
2003-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2002: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2002 form 5500 responses
2002-06-01	Type of plan entity	Single employer plan
2002-06-01	Plan funding arrangement – Insurance	Yes
2002-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2002-06-01	Plan benefit arrangement – Insurance	Yes
2002-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2001: THE OHIO MOULDING CORPORATION EMPLOYEE BENEFIT PLAN 2001 form 5500 responses
2001-06-01	Type of plan entity	Single employer plan
2001-06-01	First time form 5500 has been submitted	Yes
2001-06-01	Plan funding arrangement – Insurance	Yes
2001-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2001-06-01	Plan benefit arrangement – Insurance	Yes
2001-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	184
Insurance policy start date	2022-06-01
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 $110,954
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,773,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	110954
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	269
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,285
Total amount of fees paid to insurance company	USD $627
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,285
Amount paid for insurance broker fees	627
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	270
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $19,221
Total amount of fees paid to insurance company	USD $928
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $192,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,221
Amount paid for insurance broker fees	928
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	269
Insurance policy start date	2022-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,590
Total amount of fees paid to insurance company	USD $516
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $57,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,590
Amount paid for insurance broker fees	516
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	28
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,094
Total amount of fees paid to insurance company	USD $185
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,094
Amount paid for insurance broker fees	185
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	269
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,243
Total amount of fees paid to insurance company	USD $575
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,243
Amount paid for insurance broker fees	575
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	277
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,622
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,622
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	277
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,399
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,399
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	277
Insurance policy start date	2021-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,744
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $51,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,744
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	276
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,550
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $185,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,550
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	199
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $107,129
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,678,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	107129
Additional information about fees paid to insurance broker	ADD FEES
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	27
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,770
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,770
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	246
Insurance policy start date	2020-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,585
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $185,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,585
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	248
Insurance policy start date	2020-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,299
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $48,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,299
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	247
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,151
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,151
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	247
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,863
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,863
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	199
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $102,920
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,488,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	102920
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	29
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $2,507
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,507
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	255
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $19,360
Total amount of fees paid to insurance company	USD $71
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,360
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	185
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $98,782
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,469,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	98782
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	256
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $8,993
Total amount of fees paid to insurance company	USD $71
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,993
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	256
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $8,307
Total amount of fees paid to insurance company	USD $71
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,307
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	30
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $2,374
Total amount of fees paid to insurance company	USD $71
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,374
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	256
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $7,424
Total amount of fees paid to insurance company	USD $71
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,424
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	247
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $6,979
Total amount of fees paid to insurance company	USD $995
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $46,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,979
Amount paid for insurance broker fees	995
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	247
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $19,760
Total amount of fees paid to insurance company	USD $2,232
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,760
Amount paid for insurance broker fees	2232
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	178
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $97,385
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,434,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	97385
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	30
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,527
Total amount of fees paid to insurance company	USD $371
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,527
Amount paid for insurance broker fees	371
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	248
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $8,629
Total amount of fees paid to insurance company	USD $1,204
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,629
Amount paid for insurance broker fees	1204
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	248
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $8,098
Total amount of fees paid to insurance company	USD $1,178
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,098
Amount paid for insurance broker fees	1178
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	60
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,744
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,744
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	252
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $7,275
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $48,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,275
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	255
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $21,507
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $215,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,507
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	187
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $101,154
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,528,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	101154
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	254
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $8,750
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,750
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	254
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $8,499
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,499
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	303
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $8,552
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,552
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	50
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $2,306
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $15,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,306
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	301
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $7,070
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $47,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,070
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	217
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $97,582
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,440,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	97582
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	303
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $8,620
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,620
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	304
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $22,124
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $221,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,124
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	254
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $6,835
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,835
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	189
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $88,622
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,216,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	88622
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	254
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $18,131
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,131
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	254
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $5,811
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $38,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,811
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	254
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $7,022
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,022
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	25
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $2,151
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,151
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	26
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $2,216
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,216
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	194
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $6,405
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,405
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	193
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $5,305
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,305
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	191
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $17,328
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,328
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	193
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $6,313
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,313
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	174
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $96,211
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,405,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	96211
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	199
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $-152
Total amount of fees paid to insurance company	USD $93,388
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,124,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-152
Amount paid for insurance broker fees	93388
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS AND GENERAL AGENT PAYMENTS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	227
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $16,191
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,191
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	230
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $5,688
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,688
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	229
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $5,927
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,927
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	229
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $4,820
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,820
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	58
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $2,119
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,119
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3334867

Policy instance

Insurance contract or identification number	3334867
Number of Individuals Covered	160
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $62,397
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,559,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,397
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	200
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $11,637
Total amount of fees paid to insurance company	USD $370
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,637
Amount paid for insurance broker fees	370
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	202
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $3,550
Total amount of fees paid to insurance company	USD $305
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,550
Amount paid for insurance broker fees	305
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	30
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $2,074
Total amount of fees paid to insurance company	USD $290
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $13,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,074
Amount paid for insurance broker fees	290
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	202
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $4,240
Total amount of fees paid to insurance company	USD $348
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,240
Amount paid for insurance broker fees	348
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	203
Insurance policy start date	2001-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $4,092
Total amount of fees paid to insurance company	USD $346
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,092
Amount paid for insurance broker fees	346
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	114
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $7,730
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,730
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	116
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $2,403
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,403
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	33
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $2,096
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $13,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,096
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	116
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $2,756
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,756
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	117
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $2,738
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,738
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

123497

Policy instance

Insurance contract or identification number	123497
Number of Individuals Covered	102
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $34,510
Total amount of fees paid to insurance company	USD $1,764
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $985,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,510
Amount paid for insurance broker fees	1764
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	83
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $2,486
Total amount of fees paid to insurance company	USD $341
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,486
Amount paid for insurance broker fees	341
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	36
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $2,168
Total amount of fees paid to insurance company	USD $284
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,168
Amount paid for insurance broker fees	284
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	82
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $2,206
Total amount of fees paid to insurance company	USD $303
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,206
Amount paid for insurance broker fees	303
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	85
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $7,231
Total amount of fees paid to insurance company	USD $364
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,231
Amount paid for insurance broker fees	364
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

123497

Policy instance

Insurance contract or identification number	123497
Number of Individuals Covered	76
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $31,552
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $812,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,552
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	82
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $2,457
Total amount of fees paid to insurance company	USD $332
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,457
Amount paid for insurance broker fees	332
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	77
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $8,366
Total amount of fees paid to insurance company	USD $559
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,366
Amount paid for insurance broker fees	559
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	74
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $2,916
Total amount of fees paid to insurance company	USD $499
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,916
Amount paid for insurance broker fees	499
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	73
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $3,457
Total amount of fees paid to insurance company	USD $691
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,457
Amount paid for insurance broker fees	691
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	38
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $2,404
Total amount of fees paid to insurance company	USD $441
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $16,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,404
Amount paid for insurance broker fees	441
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	73
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $2,675
Total amount of fees paid to insurance company	USD $473
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,675
Amount paid for insurance broker fees	473
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

123497

Policy instance

Insurance contract or identification number	123497
Number of Individuals Covered	73
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $41,344
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,047,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,344
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100006802

Policy instance

Insurance contract or identification number	40000100006802
Number of Individuals Covered	56
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $2,833
Total amount of fees paid to insurance company	USD $279
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $18,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,833
Amount paid for insurance broker fees	279
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	119
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $2,942
Total amount of fees paid to insurance company	USD $519
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,942
Amount paid for insurance broker fees	519
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	120
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $4,604
Total amount of fees paid to insurance company	USD $821
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,604
Amount paid for insurance broker fees	821
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	121
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $3,108
Total amount of fees paid to insurance company	USD $549
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,108
Amount paid for insurance broker fees	549
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

123497

Policy instance

Insurance contract or identification number	123497
Number of Individuals Covered	114
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $49,980
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,140,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,980
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	119
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $9,658
Total amount of fees paid to insurance company	USD $645
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,658
Amount paid for insurance broker fees	645
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084258

Policy instance

Insurance contract or identification number	10084258
Number of Individuals Covered	143
Insurance policy start date	2006-11-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $3,063
Total amount of fees paid to insurance company	USD $289
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,063
Amount paid for insurance broker fees	289
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	152
Insurance policy start date	2006-03-01
Insurance policy end date	2006-10-31
Total amount of commissions paid to insurance broker	USD $7,092
Total amount of fees paid to insurance company	USD $7,706
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,092
Amount paid for insurance broker fees	7706
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	SAUNDERS ASSET MANAGEMENT INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084256

Policy instance

Insurance contract or identification number	10084256
Number of Individuals Covered	143
Insurance policy start date	2006-11-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $1,907
Total amount of fees paid to insurance company	USD $170
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,716
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
Amount paid for insurance broker fees	170
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D013632

Policy instance

Insurance contract or identification number	1D013632
Number of Individuals Covered	139
Insurance policy start date	2006-11-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $6,311
Total amount of fees paid to insurance company	USD $218
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,311
Amount paid for insurance broker fees	218
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10084257

Policy instance

Insurance contract or identification number	10084257
Number of Individuals Covered	143
Insurance policy start date	2006-11-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $2,032
Total amount of fees paid to insurance company	USD $192
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,032
Amount paid for insurance broker fees	192
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	FEDELI GROUP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	160
Insurance policy start date	2005-03-01
Insurance policy end date	2006-02-28
Total amount of commissions paid to insurance broker	USD $9,405
Total amount of fees paid to insurance company	USD $12,131
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,418
Amount paid for insurance broker fees	7082
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	SAUNDERS FINANCIAL ADVISORY GRP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	150
Insurance policy start date	2004-03-01
Insurance policy end date	2005-02-28
Total amount of commissions paid to insurance broker	USD $18,986
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,986
Insurance broker organization code?	3
Insurance broker name	SAUNDERS FINANCIAL ADVISORY GRP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	133
Insurance policy start date	2003-03-01
Insurance policy end date	2004-02-29
Total amount of commissions paid to insurance broker	USD $17,596
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $138,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,596
Insurance broker organization code?	3
Insurance broker name	SAUNDERS FINANCIAL ADVISORY GRP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	127
Insurance policy start date	2002-03-01
Insurance policy end date	2003-02-28
Total amount of commissions paid to insurance broker	USD $14,505
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,505
Insurance broker organization code?	3
Insurance broker name	SAUNDERS ADVISORY GROUP INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P48427

Policy instance

Insurance contract or identification number	P48427
Number of Individuals Covered	103
Insurance policy start date	2001-03-01
Insurance policy end date	2002-02-28
Total amount of commissions paid to insurance broker	USD $13,464
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,464
Insurance broker organization code?	3
Insurance broker name	SAUNDERS ADVISORY GROUP INC

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Company Name:	THE OHIO MOULDING CORPORATION
Employer identification number (EIN):	340792024
NAIC Classification:	332110