401k Plan data: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN plan

1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 401k Plan overview

Plan Name	1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN
Plan identification number	502

1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN Benefits

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

401k Sponsoring company profile

1ST MIDAMERICA CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name: 1ST MIDAMERICA CREDIT UNION

Employer identification number (EIN): 370580723

NAIC Classification: 522130
NAIC Description: Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 DANIELLE GREEN 2023-09-29
502 2021-01-01 LINDA QUIGLEY 2022-08-03
502 2020-01-01 LINDA QUIGLEY 2021-06-14
502 2019-01-01 LINDA QUIGLEY 2020-07-22
502 2018-01-01
502 2017-01-01 LINDA QUIGLEY
502 2016-01-01 MICHELLE L. SMITH
502 2015-01-01 MICHELLE L. SMITH
502 2014-01-01 MICHELLE L. SMITH
502 2013-01-01 MICHELLE L. SMITH
502 2012-01-01 MICHELLE L. SMITH
502 2011-01-01 MICHELLE L SMITH
502 2009-01-01 MICHELLE L SMITH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	DANIELLE GREEN	2023-09-29
502	2021-01-01	LINDA QUIGLEY	2022-08-03
502	2020-01-01	LINDA QUIGLEY	2021-06-14
502	2019-01-01	LINDA QUIGLEY	2020-07-22
502	2018-01-01
502	2017-01-01	LINDA QUIGLEY
502	2016-01-01	MICHELLE L. SMITH
502	2015-01-01	MICHELLE L. SMITH
502	2014-01-01	MICHELLE L. SMITH
502	2013-01-01	MICHELLE L. SMITH
502	2012-01-01	MICHELLE L. SMITH
502	2011-01-01	MICHELLE L SMITH
502	2009-01-01	MICHELLE L SMITH

Plan Statistics for 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN

401k plan membership statisitcs for 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN

Measure Date Value
2022: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 164
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 164
Number of employers contributing to the scheme 2022-01-01 0
2021: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 155
Number of retired or separated participants receiving benefits 2021-01-01 19
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 174
Number of employers contributing to the scheme 2021-01-01 0
2020: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 136
Number of retired or separated participants receiving benefits 2020-01-01 19
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 155
Number of employers contributing to the scheme 2020-01-01 0
2019: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 154
Number of retired or separated participants receiving benefits 2019-01-01 13
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 167
Number of employers contributing to the scheme 2019-01-01 0
2018: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 346
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 359
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 359
Number of employers contributing to the scheme 2018-01-01 0
2017: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 346
Total of all active and inactive participants 2017-01-01 346
2016: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 303
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 360
Total of all active and inactive participants 2016-01-01 360
2015: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 351
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 303
Total of all active and inactive participants 2015-01-01 303
2014: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 307
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 351
Total of all active and inactive participants 2014-01-01 351
2013: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 283
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 307
Total of all active and inactive participants 2013-01-01 307
Total participants 2013-01-01 0
2012: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 277
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 283
Total of all active and inactive participants 2012-01-01 283
Total participants 2012-01-01 0
2011: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 271
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 277
Total of all active and inactive participants 2011-01-01 277
Total participants 2011-01-01 277
2009: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 252
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 261
Total of all active and inactive participants 2009-01-01 261
Total participants 2009-01-01 261

Measure	Date	Value
2022: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	164
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	164
Number of employers contributing to the scheme	2022-01-01	0
2021: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	155
Number of retired or separated participants receiving benefits	2021-01-01	19
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	174
Number of employers contributing to the scheme	2021-01-01	0
2020: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	136
Number of retired or separated participants receiving benefits	2020-01-01	19
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	155
Number of employers contributing to the scheme	2020-01-01	0
2019: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	154
Number of retired or separated participants receiving benefits	2019-01-01	13
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	167
Number of employers contributing to the scheme	2019-01-01	0
2018: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	359
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	359
Number of employers contributing to the scheme	2018-01-01	0
2017: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	346
Total of all active and inactive participants	2017-01-01	346
2016: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	303
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	360
Total of all active and inactive participants	2016-01-01	360
2015: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	351
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	303
Total of all active and inactive participants	2015-01-01	303
2014: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	307
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	351
Total of all active and inactive participants	2014-01-01	351
2013: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	283
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	307
Total of all active and inactive participants	2013-01-01	307
Total participants	2013-01-01	0
2012: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	277
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	283
Total of all active and inactive participants	2012-01-01	283
Total participants	2012-01-01	0
2011: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	271
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	277
Total of all active and inactive participants	2011-01-01	277
Total participants	2011-01-01	277
2009: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	252
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	261
Total of all active and inactive participants	2009-01-01	261
Total participants	2009-01-01	261

Form 5500 Responses for 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN

2022: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE 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: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: 1ST MIDAMERICA CREDIT UNION EMPLOYEE BENEFITS WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30101489

Policy instance

Insurance contract or identification number	30101489
Number of Individuals Covered	113
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,175
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,175
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

892587G

Policy instance

Insurance contract or identification number	892587G
Number of Individuals Covered	164
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,562
Total amount of fees paid to insurance company	USD $3,015
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $133,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,562
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	134
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	264
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $54,847
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,877,009
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	54847
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	306
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $46,641
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,964,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	29122
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $0

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	142
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

892587G

Policy instance

Insurance contract or identification number	892587G
Number of Individuals Covered	155
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,547
Total amount of fees paid to insurance company	USD $7,446
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $122,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,492
Amount paid for insurance broker fees	7446
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30101489

Policy instance

Insurance contract or identification number	30101489
Number of Individuals Covered	115
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,501
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $783
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98651891001

Policy instance

Insurance contract or identification number	98651891001
Number of Individuals Covered	281
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,704
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,704
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

5750370

Policy instance

Insurance contract or identification number	5750370
Number of Individuals Covered	380
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,941
Total amount of fees paid to insurance company	USD $1,847
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $133,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,941
Amount paid for insurance broker fees	179
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	161
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	323
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $-4,170
Total amount of fees paid to insurance company	USD $53,185
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,613,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-4,170
Amount paid for insurance broker fees	53185
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	351
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,170
Total amount of fees paid to insurance company	USD $46,456
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,114,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,170
Amount paid for insurance broker fees	46446
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	173
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

5750370

Policy instance

Insurance contract or identification number	5750370
Number of Individuals Covered	392
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,028
Total amount of fees paid to insurance company	USD $1,010
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $84,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,028
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98651891001

Policy instance

Insurance contract or identification number	98651891001
Number of Individuals Covered	296
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,794
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,794
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	347
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $48,807
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,908,101
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	48807
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	359
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,502
Total amount of fees paid to insurance company	USD $1,213
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $76,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,502
Amount paid for insurance broker fees	60
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	170
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98651891001

Policy instance

Insurance contract or identification number	98651891001
Number of Individuals Covered	267
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,867
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,867
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	346
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,256
Total amount of fees paid to insurance company	USD $2,346
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $79,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,256
Amount paid for insurance broker fees	51
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	USI INS SERVICES LLC

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	160
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98651891001

Policy instance

Insurance contract or identification number	98651891001
Number of Individuals Covered	271
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,715
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,715
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES, LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	326
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $48,616
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,706,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5960
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	USI INS SERVICES LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	293
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $37,301
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,492,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	31109
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9865189

Policy instance

Insurance contract or identification number	9865189
Number of Individuals Covered	224
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,256
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,135
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	150
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	303
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,406
Total amount of fees paid to insurance company	USD $1,285
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $70,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,907
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATION INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

711279

Policy instance

Insurance contract or identification number	711279
Number of Individuals Covered	265
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $-11
Total amount of fees paid to insurance company	USD $38,363
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 $1,278,422
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
Amount paid for insurance broker fees	38363
Insurance broker name	HOLMES MURPHY & ASSOCIATES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9865189

Policy instance

Insurance contract or identification number	9865189
Number of Individuals Covered	227
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,570
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,570
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	148
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $75,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	351
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,555
Total amount of fees paid to insurance company	USD $1,017
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $56,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,555
Amount paid for insurance broker fees	1017
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATION INC

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	307
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,064
Total amount of fees paid to insurance company	USD $255
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $60,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,064
Amount paid for insurance broker fees	255
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATION INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0711279

Policy instance

Insurance contract or identification number	0711279
Number of Individuals Covered	125
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $32,272
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $984,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,272
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9865189

Policy instance

Insurance contract or identification number	9865189
Number of Individuals Covered	198
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	128
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	126
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30006298

Policy instance

Insurance contract or identification number	30006298
Number of Individuals Covered	75
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $768
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $768
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	283
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,240
Total amount of fees paid to insurance company	USD $12
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $46,157
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	12
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0711279

Policy instance

Insurance contract or identification number	0711279
Number of Individuals Covered	265
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $31,386
Total amount of fees paid to insurance company	USD $3,575
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,047,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,386
Amount paid for insurance broker fees	3575
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0711279

Policy instance

Insurance contract or identification number	0711279
Number of Individuals Covered	265
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $31,582
Total amount of fees paid to insurance company	USD $6,765
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,050,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30006298

Policy instance

Insurance contract or identification number	30006298
Number of Individuals Covered	82
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $760
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	132
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	277
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,508
Total amount of fees paid to insurance company	USD $1,000
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $49,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0711279

Policy instance

Insurance contract or identification number	0711279
Number of Individuals Covered	265
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $29,792
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,005,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,792
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10149

Policy instance

Insurance contract or identification number	10149
Number of Individuals Covered	125
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30006298

Policy instance

Insurance contract or identification number	30006298
Number of Individuals Covered	67
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $675
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $675
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOCIATES

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

Policy contract number

KM05750370

Policy instance

Insurance contract or identification number	KM05750370
Number of Individuals Covered	271
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,196
Total amount of fees paid to insurance company	USD $914
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,196
Amount paid for insurance broker fees	914
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES MURPHY & ASSOC INC

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Company Name:	1ST MIDAMERICA CREDIT UNION
Employer identification number (EIN):	370580723
NAIC Classification:	522130
NAIC Description:	Credit Unions