401k Plan data: KARAVAN TRAILERS, INC HEALTH PLAN plan

KARAVAN TRAILERS, INC HEALTH PLAN 401k Plan overview

Plan Name	KARAVAN TRAILERS, INC HEALTH PLAN
Plan identification number	501

KARAVAN TRAILERS, INC HEALTH 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 Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

KARAVAN TRAILERS, LLC. has sponsored the creation of one or more 401k plans.

Company Name: KARAVAN TRAILERS, LLC.

Employer identification number (EIN): 391561090

NAIC Classification: 336990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KARAVAN TRAILERS, INC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2019-01-01
501 2018-01-01 JAMES CURTIN A2118156 2019-07-10
501 2017-01-01 JAMES CURTIN JAMES CURTIN 2018-07-09
501 2016-01-01 JAMES CURTIN JAMES CURTIN 2017-07-13
501 2015-01-01 JAMES CURTIN JAMES CURTIN 2016-07-12
501 2014-01-01 JAMES CURTIN JAMES CURTIN 2015-07-23
501 2013-01-01 EDWARD DE TUNCQ EDWARD DE TUNCQ 2014-07-15
501 2012-01-01 EDWARD DE TUNCQ EDWARD DE TUNCQ 2013-10-10
501 2011-01-01 EDWARD DE TUNCQ EDWARD DE TUNCQ 2012-07-25
501 2010-01-01 EDWARD DE TUNCQ EDWARD DE TUNCQ 2011-08-01
501 2009-01-01 EDWARD DE TUNCQ EDWARD DE TUNCQ 2010-08-20

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01
501	2019-01-01
501	2018-01-01	JAMES CURTIN	A2118156	2019-07-10
501	2017-01-01	JAMES CURTIN	JAMES CURTIN	2018-07-09
501	2016-01-01	JAMES CURTIN	JAMES CURTIN	2017-07-13
501	2015-01-01	JAMES CURTIN	JAMES CURTIN	2016-07-12
501	2014-01-01	JAMES CURTIN	JAMES CURTIN	2015-07-23
501	2013-01-01	EDWARD DE TUNCQ	EDWARD DE TUNCQ	2014-07-15
501	2012-01-01	EDWARD DE TUNCQ	EDWARD DE TUNCQ	2013-10-10
501	2011-01-01	EDWARD DE TUNCQ	EDWARD DE TUNCQ	2012-07-25
501	2010-01-01	EDWARD DE TUNCQ	EDWARD DE TUNCQ	2011-08-01
501	2009-01-01	EDWARD DE TUNCQ	EDWARD DE TUNCQ	2010-08-20

Plan Statistics for KARAVAN TRAILERS, INC HEALTH PLAN

401k plan membership statisitcs for KARAVAN TRAILERS, INC HEALTH PLAN

Measure Date Value
2019: KARAVAN TRAILERS, INC HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 83
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 89
Number of retired or separated participants receiving benefits 2019-01-01 0
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 89
2018: KARAVAN TRAILERS, INC HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 83
Total of all active and inactive participants 2018-01-01 83
2017: KARAVAN TRAILERS, INC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 86
Total of all active and inactive participants 2017-01-01 86
2016: KARAVAN TRAILERS, INC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 76
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 78
Total of all active and inactive participants 2016-01-01 78
2015: KARAVAN TRAILERS, INC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 67
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 76
Total of all active and inactive participants 2015-01-01 76
2014: KARAVAN TRAILERS, INC HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 67
Number of retired or separated participants receiving benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 68
2013: KARAVAN TRAILERS, INC HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 57
Total of all active and inactive participants 2013-01-01 57
2012: KARAVAN TRAILERS, INC HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 58
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 58
2011: KARAVAN TRAILERS, INC HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 48
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 48
2010: KARAVAN TRAILERS, INC HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 93
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 93
2009: KARAVAN TRAILERS, INC HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 96
Number of retired or separated participants receiving benefits 2009-01-01 5
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 101

Measure	Date	Value
2019: KARAVAN TRAILERS, INC HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	83
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	89
Number of retired or separated participants receiving benefits	2019-01-01	0
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	89
2018: KARAVAN TRAILERS, INC HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	83
Total of all active and inactive participants	2018-01-01	83
2017: KARAVAN TRAILERS, INC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	86
Total of all active and inactive participants	2017-01-01	86
2016: KARAVAN TRAILERS, INC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	78
Total of all active and inactive participants	2016-01-01	78
2015: KARAVAN TRAILERS, INC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	67
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	76
Total of all active and inactive participants	2015-01-01	76
2014: KARAVAN TRAILERS, INC HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	67
Number of retired or separated participants receiving benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	68
2013: KARAVAN TRAILERS, INC HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	57
Total of all active and inactive participants	2013-01-01	57
2012: KARAVAN TRAILERS, INC HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	58
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	58
2011: KARAVAN TRAILERS, INC HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	48
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	48
2010: KARAVAN TRAILERS, INC HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	93
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	93
2009: KARAVAN TRAILERS, INC HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	96
Number of retired or separated participants receiving benefits	2009-01-01	5
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	101

Form 5500 Responses for KARAVAN TRAILERS, INC HEALTH PLAN

2019: KARAVAN TRAILERS, INC HEALTH PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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: KARAVAN TRAILERS, INC HEALTH 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
2010: KARAVAN TRAILERS, INC HEALTH PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: KARAVAN TRAILERS, INC HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

926421

Policy instance

Insurance contract or identification number	926421
Number of Individuals Covered	9
Insurance policy start date	2019-03-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $477
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $477
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

GLUG050H7

Policy instance

Insurance contract or identification number	GLUG050H7
Number of Individuals Covered	216
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $609
Total amount of fees paid to insurance company	USD $305
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $6,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $609
Amount paid for insurance broker fees	305
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	134
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,808
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $379,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,808
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	13
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $220
Total amount of fees paid to insurance company	USD $58
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	SHORT TERM DISABILITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	125
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,306
Total amount of fees paid to insurance company	USD $131
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $44,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,306
Amount paid for insurance broker fees	131
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU128

Policy instance

Insurance contract or identification number	AU128
Number of Individuals Covered	9
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $423
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $127
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00023836

Policy instance

Insurance contract or identification number	ER00023836
Number of Individuals Covered	91
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,440
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $32,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,733
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	14
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $989
Total amount of fees paid to insurance company	USD $241
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $539
Insurance broker organization code?	3
Amount paid for insurance broker fees	179
Additional information about fees paid to insurance broker	CLAIMS ADMINISTRATIVE SERVICES

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00023836

Policy instance

Insurance contract or identification number	ER00023836
Number of Individuals Covered	122
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,317
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $39,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,119
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
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 $2,450
Total amount of fees paid to insurance company	USD $136
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,450
Amount paid for insurance broker fees	136
Insurance broker organization code?	3

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	141
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $15,744
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $412,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,744
Insurance broker organization code?	3

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

Policy contract number

GLUG050H7

Policy instance

Insurance contract or identification number	GLUG050H7
Number of Individuals Covered	216
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $609
Total amount of fees paid to insurance company	USD $368
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $609
Amount paid for insurance broker fees	368
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00023836

Policy instance

Insurance contract or identification number	ER00023836
Number of Individuals Covered	185
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,083
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $51,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,587
Insurance broker organization code?	3
Insurance broker name	CANSAS A STEIDL

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	134
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,342
Total amount of fees paid to insurance company	USD $105
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,342
Amount paid for insurance broker fees	105
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	170
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $15,864
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $463,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,864
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	16
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,156
Total amount of fees paid to insurance company	USD $282
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $630
Insurance broker organization code?	3
Amount paid for insurance broker fees	209
Additional information about fees paid to insurance broker	CLAIMS ADMINISTRATIVE SERVICES
Insurance broker name	TOWERS PERRIN FORSTER & CROSBY, INC

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

Policy contract number

GLUG050H7

Policy instance

Insurance contract or identification number	GLUG050H7
Number of Individuals Covered	216
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $609
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $609
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

GLUG050H7

Policy instance

Insurance contract or identification number	GLUG050H7
Number of Individuals Covered	201
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $500
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $500
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	18
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,350
Total amount of fees paid to insurance company	USD $330
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $5,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $736
Insurance broker organization code?	3
Amount paid for insurance broker fees	245
Insurance broker name	TOWERS PERRIN FORSTER & CROSBY, INC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	137
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,124
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $431,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,124
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	121
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,634
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 $47,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,634
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 )

Policy contract number

3000

Policy instance

Insurance contract or identification number	3000
Number of Individuals Covered	9
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $170
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $170
Insurance broker organization code?	3
Insurance broker name	ADMINISTRATIVE SERVICES

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

Policy instance

Number of Individuals Covered	29
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,241
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $11,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,241
Insurance broker organization code?	3
Insurance broker name	MIDWEST SELECT INSURANCE GROUP

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

11492

Policy instance

Insurance contract or identification number	11492
Number of Individuals Covered	84
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,149
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $16,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,503
Insurance broker organization code?	3
Insurance broker name	RYAN S SHADEL

BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 )

Policy contract number

3000

Policy instance

Insurance contract or identification number	3000
Number of Individuals Covered	9
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $169
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $169
Insurance broker organization code?	3
Insurance broker name	ADMINISTRATIVE SERVICES

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	116
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $2,099
Total amount of fees paid to insurance company	USD $105
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,099
Amount paid for insurance broker fees	105
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	121
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,242
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $336,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,242
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	19
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,453
Total amount of fees paid to insurance company	USD $355
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $802
Insurance broker organization code?	3
Amount paid for insurance broker fees	263
Insurance broker name	TOWERS PERRIN FORSTER & CROSBY, INC

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

Policy contract number

GLUG050H7

Policy instance

Insurance contract or identification number	GLUG050H7
Number of Individuals Covered	191
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $462
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $462
Insurance broker organization code?	3
Insurance broker name	SECURITY INSURANCE SERVICE

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

11492

Policy instance

Insurance contract or identification number	11492
Number of Individuals Covered	71
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,852
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $18,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,315
Insurance broker organization code?	3
Insurance broker name	CHRISTINE LOGSLETT

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

Policy contract number

GLUG 050H7

Policy instance

Insurance contract or identification number	GLUG 050H7
Number of Individuals Covered	181
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $435
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $435
Insurance broker organization code?	3
Insurance broker name	SECURITY INSURANCE SERVICE

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	102
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $11,997
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $312,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,997
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	19
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,457
Total amount of fees paid to insurance company	USD $384
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $808
Insurance broker organization code?	3
Amount paid for insurance broker fees	285
Insurance broker name	TOWERS PERRIN FORSTER & CROSBY, INC

BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 )

Policy contract number

3000

Policy instance

Insurance contract or identification number	3000
Number of Individuals Covered	13
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $213
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $213
Insurance broker organization code?	3
Insurance broker name	ADMINISTRATIVE SERVICES

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	112
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $1,960
Total amount of fees paid to insurance company	USD $54
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,960
Amount paid for insurance broker fees	54
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

3141

Policy instance

Insurance contract or identification number	3141
Number of Individuals Covered	105
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $14,015
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,015
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	105
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $1,928
Total amount of fees paid to insurance company	USD $251
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,928
Amount paid for insurance broker fees	251
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	19
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $1,457
Total amount of fees paid to insurance company	USD $384
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $808
Insurance broker organization code?	3
Amount paid for insurance broker fees	285
Additional information about fees paid to insurance broker	FINDERS FEE
Insurance broker name	TOWERS PERRIN FORSTER & CROSBY, INC

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

Policy contract number

GLUG 050H7

Policy instance

Insurance contract or identification number	GLUG 050H7
Number of Individuals Covered	182
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $385
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $385
Insurance broker organization code?	3
Insurance broker name	SECURITY INSURANCE SERVICE

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-029827

Policy instance

Insurance contract or identification number	010-029827
Number of Individuals Covered	103
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $1,935
Total amount of fees paid to insurance company	USD $366
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG 050H7

Policy instance

Insurance contract or identification number	GLUG 050H7
Number of Individuals Covered	139
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $334
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	21
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-28
Total amount of commissions paid to insurance broker	USD $1,560
Total amount of fees paid to insurance company	USD $382
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

31410-31412-V

Policy instance

Insurance contract or identification number	31410-31412-V
Number of Individuals Covered	88
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,436
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG 050H7

Policy instance

Insurance contract or identification number	GLUG 050H7
Number of Individuals Covered	139
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $312
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $3,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $312
Insurance broker organization code?	3
Insurance broker name	UNIVERSAL BENEFITS GROUP LLC

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

31410-31415

Policy instance

Insurance contract or identification number	31410-31415
Number of Individuals Covered	93
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,477
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $243,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,477
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

7007224

Policy instance

Insurance contract or identification number	7007224
Number of Individuals Covered	22
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $1,536
Total amount of fees paid to insurance company	USD $469
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $849
Insurance broker organization code?	3
Amount paid for insurance broker fees	300
Additional information about fees paid to insurance broker	CLAIMS ADMINISTRATIVE SERVICES
Insurance broker name	WHA FINANCIAL SOLUTIONS

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Company Name:	KARAVAN TRAILERS, LLC.
Employer identification number (EIN):	391561090
NAIC Classification:	336990