401k Plan data: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN plan

CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN
Plan identification number	506

CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CENTRAL SUPPLY COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL SUPPLY COMPANY, INC.

Employer identification number (EIN): 351358209

NAIC Classification: 423700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2023-01-01 JOSEPH D HUGHES 2024-07-15
506 2022-01-01 JOSEPH D HUGHES 2023-06-27
506 2021-01-01 JOSEPH D HUGHES 2022-07-11
506 2020-01-01 JOSEPH D HUGHES 2021-07-26
506 2019-01-01
506 2018-01-01 JOSEPH D HUGHES
506 2017-01-01 JOSEPH D HUGHES
506 2016-01-01 JOSEPH D HUGHES
506 2015-01-01 JOSEPH D HUGHES
506 2014-01-01 JOSEPH D HUGHES

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
506	2023-01-01	JOSEPH D HUGHES	2024-07-15
506	2022-01-01	JOSEPH D HUGHES	2023-06-27
506	2021-01-01	JOSEPH D HUGHES	2022-07-11
506	2020-01-01	JOSEPH D HUGHES	2021-07-26
506	2019-01-01
506	2018-01-01	JOSEPH D HUGHES
506	2017-01-01	JOSEPH D HUGHES
506	2016-01-01	JOSEPH D HUGHES
506	2015-01-01	JOSEPH D HUGHES
506	2014-01-01	JOSEPH D HUGHES

Plan Statistics for CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN

Measure Date Value
2023: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 187
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 232
Total of all active and inactive participants 2023-01-01 232
Total participants 2023-01-01 232
2022: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 187
Total of all active and inactive participants 2022-01-01 187
Total participants 2022-01-01 187
2021: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 161
Total of all active and inactive participants 2021-01-01 161
Total participants 2021-01-01 161
2020: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 137
Total of all active and inactive participants 2020-01-01 137
Total participants 2020-01-01 137
2019: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 156
Total of all active and inactive participants 2019-01-01 156
Total participants 2019-01-01 156
Number of participants with account balances 2019-01-01 0
2018: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 150
Total of all active and inactive participants 2018-01-01 150
Total participants 2018-01-01 150
2017: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 153
Total of all active and inactive participants 2017-01-01 153
Total participants 2017-01-01 153
2016: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 139
Total of all active and inactive participants 2016-01-01 139
Total participants 2016-01-01 139
2015: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 242
Total of all active and inactive participants 2015-01-01 242
Total participants 2015-01-01 0
2014: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 126
Total of all active and inactive participants 2014-01-01 126
Total participants 2014-01-01 0

Measure	Date	Value
2023: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	187
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	232
Total of all active and inactive participants	2023-01-01	232
Total participants	2023-01-01	232
2022: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	187
Total of all active and inactive participants	2022-01-01	187
Total participants	2022-01-01	187
2021: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	161
Total of all active and inactive participants	2021-01-01	161
Total participants	2021-01-01	161
2020: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	137
Total of all active and inactive participants	2020-01-01	137
Total participants	2020-01-01	137
2019: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	156
Total of all active and inactive participants	2019-01-01	156
Total participants	2019-01-01	156
Number of participants with account balances	2019-01-01	0
2018: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	150
Total of all active and inactive participants	2018-01-01	150
Total participants	2018-01-01	150
2017: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	153
Total of all active and inactive participants	2017-01-01	153
Total participants	2017-01-01	153
2016: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	139
Total of all active and inactive participants	2016-01-01	139
Total participants	2016-01-01	139
2015: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	242
Total of all active and inactive participants	2015-01-01	242
Total participants	2015-01-01	0
2014: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	126
Total of all active and inactive participants	2014-01-01	126
Total participants	2014-01-01	0

Form 5500 Responses for CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN

2023: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CENTRAL SUPPLY COMPANY, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 184623

Policy instance

Insurance contract or identification number	VG 184623
Number of Individuals Covered	80
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,837
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $32,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	232
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,457
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $12,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	194
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,116
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	211
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,864
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $24,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	332
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $14,388
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $143,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 825386

Policy instance

Insurance contract or identification number	VAI 825386
Number of Individuals Covered	27
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,225
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	166
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,923
Total amount of fees paid to insurance company	USD $582
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $22,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,923
Amount paid for insurance broker fees	582
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	341
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,311
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,311
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	161
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,726
Total amount of fees paid to insurance company	USD $913
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,726
Amount paid for insurance broker fees	913
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	187
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,142
Total amount of fees paid to insurance company	USD $213
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $10,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,142
Amount paid for insurance broker fees	213
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 184623

Policy instance

Insurance contract or identification number	VG 184623
Number of Individuals Covered	86
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,093
Total amount of fees paid to insurance company	USD $742
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $27,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,093
Amount paid for insurance broker fees	742
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 825386

Policy instance

Insurance contract or identification number	VAI 825386
Number of Individuals Covered	29
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,316
Total amount of fees paid to insurance company	USD $136
Other welfare benefits provided	VOLUNTARY ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,316
Amount paid for insurance broker fees	136
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	279
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,278
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,278
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	150
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,592
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $16,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,592
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	147
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,914
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,914
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	161
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,218
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $6,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,218
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 184623

Policy instance

Insurance contract or identification number	VG 184623
Number of Individuals Covered	33
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,181
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,181
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 825386

Policy instance

Insurance contract or identification number	VAI 825386
Number of Individuals Covered	14
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $775
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $775
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 184623

Policy instance

Insurance contract or identification number	VG 184623
Number of Individuals Covered	23
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,900
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $12,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,900
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	137
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $892
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $892
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	131
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,320
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,320
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	133
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,282
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $13,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,282
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	266
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $10,675
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,675
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 825386

Policy instance

Insurance contract or identification number	VAI 825386
Number of Individuals Covered	13
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $503
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $2,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $503
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 825386

Policy instance

Insurance contract or identification number	VAI 825386
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $684
Total amount of fees paid to insurance company	USD $34
Other welfare benefits provided	VOLUNTARY ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $684
Insurance broker organization code?	3
Amount paid for insurance broker fees	34
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	242
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,445
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,445
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	150
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,625
Total amount of fees paid to insurance company	USD $202
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $17,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,625
Insurance broker organization code?	3
Amount paid for insurance broker fees	202
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	148
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,427
Total amount of fees paid to insurance company	USD $321
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,427
Insurance broker organization code?	3
Amount paid for insurance broker fees	321
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	156
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $939
Total amount of fees paid to insurance company	USD $52
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $939
Insurance broker organization code?	3
Amount paid for insurance broker fees	52
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VG 184623

Policy instance

Insurance contract or identification number	VG 184623
Number of Individuals Covered	21
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,784
Total amount of fees paid to insurance company	USD $131
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $11,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,784
Insurance broker organization code?	3
Amount paid for insurance broker fees	131
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	150
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $829
Total amount of fees paid to insurance company	USD $211
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $829
Amount paid for insurance broker fees	141
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	143
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,854
Total amount of fees paid to insurance company	USD $1,153
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,854
Amount paid for insurance broker fees	769
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	145
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,431
Total amount of fees paid to insurance company	USD $744
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $16,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,431
Amount paid for insurance broker fees	496
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	288
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,933
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,933
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	264
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,981
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,981
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	147
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,614
Total amount of fees paid to insurance company	USD $1,326
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,614
Amount paid for insurance broker fees	978
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	PROSENTIAL BENEFITS, LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	147
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,807
Total amount of fees paid to insurance company	USD $870
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $19,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,807
Amount paid for insurance broker fees	642
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	PROSENTIAL BENEFITS, LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	153
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,126
Total amount of fees paid to insurance company	USD $235
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,126
Amount paid for insurance broker fees	173
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	PROSENTIAL BENEFITS, LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007356

Policy instance

Insurance contract or identification number	136-007356
Number of Individuals Covered	242
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,831
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,831
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 153433

Policy instance

Insurance contract or identification number	GL 153433
Number of Individuals Covered	127
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,610
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $17,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,610
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 125728

Policy instance

Insurance contract or identification number	LTD 125728
Number of Individuals Covered	127
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,697
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,697
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 800381

Policy instance

Insurance contract or identification number	VCI 800381
Number of Individuals Covered	134
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $908
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $908
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )

Policy contract number

30029908

Policy instance

Insurance contract or identification number	30029908
Number of Individuals Covered	64
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $777
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $644
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	APEX BENEFIT GROUP INC

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

Policy contract number

400001000 14343

Policy instance

Insurance contract or identification number	400001000 14343
Number of Individuals Covered	32
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $762
Total amount of fees paid to insurance company	USD $155
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $5,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $568
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Amount paid for insurance broker fees	155
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

000010151852

Policy instance

Insurance contract or identification number	000010151852
Number of Individuals Covered	126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,554
Total amount of fees paid to insurance company	USD $707
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,624
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Amount paid for insurance broker fees	707
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

000010151851

Policy instance

Insurance contract or identification number	000010151851
Number of Individuals Covered	126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,485
Total amount of fees paid to insurance company	USD $429
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D LIFE
Welfare Benefit Premiums Paid to Carrier	USD $16,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,849
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Amount paid for insurance broker fees	429
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

00001D023140

Policy instance

Insurance contract or identification number	00001D023140
Number of Individuals Covered	105
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,570
Total amount of fees paid to insurance company	USD $665
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,094
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Amount paid for insurance broker fees	665
Insurance broker name	HYLANT GROUP INC

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Company Name:	CENTRAL SUPPLY COMPANY, INC.
Employer identification number (EIN):	351358209
NAIC Classification:	423700