401k Plan data: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN plan

MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT 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

401k Sponsoring company profile

MFA OIL COMPANY has sponsored the creation of one or more 401k plans.

Company Name: MFA OIL COMPANY

Employer identification number (EIN): 430415115

NAIC Classification: 424700

Additional information about MFA OIL COMPANY

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 1983233

More information about MFA OIL COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 JANICE SERPICO
501 2017-01-01 JANICE SERPICO
501 2016-01-01 JANICE SERPICO
501 2015-01-01 JANICE SERPICO
501 2014-01-01 TOM MAY
501 2013-01-01 TOM MAY
501 2012-01-01 TOM MAY
501 2011-01-01 TOM MAY
501 2010-01-01 BEV PFEFFER
501 2009-09-01 BEV PFEFFER

Plan Statistics for MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2023: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 1,189
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 1,340
Number of retired or separated participants receiving benefits 2023-01-01 13
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 1,353
2022: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,136
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,183
Number of retired or separated participants receiving benefits 2022-01-01 22
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 1,205
2021: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,118
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,117
Number of retired or separated participants receiving benefits 2021-01-01 16
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 1,133
2020: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,137
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,110
Number of retired or separated participants receiving benefits 2020-01-01 12
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 1,122
2019: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,164
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,115
Number of retired or separated participants receiving benefits 2019-01-01 43
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 1,158
2018: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,116
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,146
Number of retired or separated participants receiving benefits 2018-01-01 24
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 1,170
2017: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,157
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,090
Number of retired or separated participants receiving benefits 2017-01-01 34
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 1,124
2016: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 927
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,118
Number of retired or separated participants receiving benefits 2016-01-01 39
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 1,157
2015: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 930
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 927
Number of retired or separated participants receiving benefits 2015-01-01 15
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 942
2014: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,028
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 923
Number of retired or separated participants receiving benefits 2014-01-01 7
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 930
2013: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 905
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 916
Number of retired or separated participants receiving benefits 2013-01-01 112
Total of all active and inactive participants 2013-01-01 1,028
2012: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 910
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 905
Number of retired or separated participants receiving benefits 2012-01-01 115
Total of all active and inactive participants 2012-01-01 1,020
2011: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 928
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 910
Number of retired or separated participants receiving benefits 2011-01-01 108
Total of all active and inactive participants 2011-01-01 1,018
2010: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 928
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 928
Number of retired or separated participants receiving benefits 2010-01-01 47
Total of all active and inactive participants 2010-01-01 975
2009: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 843
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 928
Total of all active and inactive participants 2009-09-01 928

Measure	Date	Value
2023: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	1,189
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	1,340
Number of retired or separated participants receiving benefits	2023-01-01	13
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	1,353
2022: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,136
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,183
Number of retired or separated participants receiving benefits	2022-01-01	22
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	1,205
2021: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,118
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,117
Number of retired or separated participants receiving benefits	2021-01-01	16
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	1,133
2020: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,137
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,110
Number of retired or separated participants receiving benefits	2020-01-01	12
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	1,122
2019: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,164
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,115
Number of retired or separated participants receiving benefits	2019-01-01	43
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	1,158
2018: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,116
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,146
Number of retired or separated participants receiving benefits	2018-01-01	24
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	1,170
2017: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,157
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,090
Number of retired or separated participants receiving benefits	2017-01-01	34
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,124
2016: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	927
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,118
Number of retired or separated participants receiving benefits	2016-01-01	39
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	1,157
2015: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	930
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	927
Number of retired or separated participants receiving benefits	2015-01-01	15
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	942
2014: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,028
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	923
Number of retired or separated participants receiving benefits	2014-01-01	7
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	930
2013: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	905
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	916
Number of retired or separated participants receiving benefits	2013-01-01	112
Total of all active and inactive participants	2013-01-01	1,028
2012: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	910
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	905
Number of retired or separated participants receiving benefits	2012-01-01	115
Total of all active and inactive participants	2012-01-01	1,020
2011: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	928
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	910
Number of retired or separated participants receiving benefits	2011-01-01	108
Total of all active and inactive participants	2011-01-01	1,018
2010: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	928
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	928
Number of retired or separated participants receiving benefits	2010-01-01	47
Total of all active and inactive participants	2010-01-01	975
2009: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	843
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	928
Total of all active and inactive participants	2009-09-01	928

Form 5500 Responses for MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN

2023: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan 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: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan 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: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan 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: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MFA OIL COMPANY COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	448
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,440
Total amount of fees paid to insurance company	USD $8,170
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $238,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21700000

Policy instance

Insurance contract or identification number	21700000
Number of Individuals Covered	1598
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $17,424
Total amount of fees paid to insurance company	USD $1,940
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $378,676
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

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1340
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $5,193
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $167,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1737
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $20,358
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

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	893
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $5,442
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,160
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

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1748
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,006
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: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	672
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,752
Vision Insurance Welfare Benefit	Yes
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

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	893
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $8,750
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $274,168
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: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	584
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,389
Total amount of fees paid to insurance company	USD $738
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $23,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21700000

Policy instance

Insurance contract or identification number	21700000
Number of Individuals Covered	1430
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $25,219
Total amount of fees paid to insurance company	USD $3,805
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $419,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,219
Amount paid for insurance broker fees	3805
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1183
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $4,823
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $149,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4823
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	401
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,417
Total amount of fees paid to insurance company	USD $8,385
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $233,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,417
Amount paid for insurance broker fees	8385
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	895
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $5,094
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5094
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1610
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Welfare Benefit Premiums Paid to Carrier	USD $638,720
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

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	895
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $8,750
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $257,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8750
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	486
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,118
Total amount of fees paid to insurance company	USD $702
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $21,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,118
Amount paid for insurance broker fees	702
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1737
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $20,358
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: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	589
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,077
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,077
Insurance broker organization code?	3

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21700000

Policy instance

Insurance contract or identification number	21700000
Number of Individuals Covered	1423
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,796
Total amount of fees paid to insurance company	USD $3,696
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $408,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,796
Amount paid for insurance broker fees	3696
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1117
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $5,566
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $138,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5566
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1870
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $20,358
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

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	852
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $5,677
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5677
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1690
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $50,499
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: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	566
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,370
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,370
Insurance broker organization code?	3

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

Policy contract number

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	852
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $9,563
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $256,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9563
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	504
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,988
Total amount of fees paid to insurance company	USD $817
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,988
Insurance broker organization code?	3
Amount paid for insurance broker fees	817
Additional information about fees paid to insurance broker	OTHER COMPENSATION

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	403
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,431
Total amount of fees paid to insurance company	USD $9,929
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $236,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9929
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $6,431

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21700000

Policy instance

Insurance contract or identification number	21700000
Number of Individuals Covered	1430
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,991
Total amount of fees paid to insurance company	USD $2,458
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $294,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,991
Amount paid for insurance broker fees	2458
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1110
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $6,781
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $136,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6781
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	421
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,463
Total amount of fees paid to insurance company	USD $11,322
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $242,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11322
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $6,463

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	864
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $5,639
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5639
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1801
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,640
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: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	573
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,230
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,230
Insurance broker organization code?	3

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

Policy contract number

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	862
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $9,953
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $233,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9953
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	498
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,003
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $20,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,003
Insurance broker organization code?	3

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1870
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $20,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

21700000

Policy instance

Insurance contract or identification number	21700000
Number of Individuals Covered	1425
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,341
Total amount of fees paid to insurance company	USD $8,770
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $327,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,341
Amount paid for insurance broker fees	8770
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1115
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,641
Total amount of fees paid to insurance company	USD $6,197
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $139,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6197
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,641

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	428
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,451
Total amount of fees paid to insurance company	USD $9,700
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $240,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9700
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $6,451

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	854
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,157
Total amount of fees paid to insurance company	USD $5,213
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5213
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,157

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1791
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $87,775
Welfare Benefit Premiums Paid to Carrier	USD $638,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,775
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	542
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,610
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,610
Insurance broker organization code?	3

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

Policy contract number

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	854
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,205
Total amount of fees paid to insurance company	USD $9,435
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,205
Insurance broker organization code?	3
Amount paid for insurance broker fees	9435
Additional information about fees paid to insurance broker	OTHER COMPENSATION

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	497
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,983
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,983
Insurance broker organization code?	3

EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1870
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $20,358
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: 71412 )

Policy contract number

GMDC0AA0W

Policy instance

Insurance contract or identification number	GMDC0AA0W
Number of Individuals Covered	508
Insurance policy start date	2018-11-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $336
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $336
Insurance broker organization code?	3

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

Policy contract number

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	887
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,220
Total amount of fees paid to insurance company	USD $11,483
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11483
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $10,220

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	542
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,266
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,266
Insurance broker organization code?	3

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1823
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $84,788
Welfare Benefit Premiums Paid to Carrier	USD $618,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,788
Insurance broker organization code?	3

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	887
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,147
Total amount of fees paid to insurance company	USD $5,922
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5922
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,147

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	390
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,326
Total amount of fees paid to insurance company	USD $9,654
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $215,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9654
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $6,326

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1146
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,618
Total amount of fees paid to insurance company	USD $6,882
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $136,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6882
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,618

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

Policy contract number

0174739

Policy instance

Insurance contract or identification number	0174739
Number of Individuals Covered	1372
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $17,333
Total amount of fees paid to insurance company	USD $7,474
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $344,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,333
Amount paid for insurance broker fees	7474
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

174739

Policy instance

Insurance contract or identification number	174739
Number of Individuals Covered	1275
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,333
Total amount of fees paid to insurance company	USD $5,435
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $321,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,333
Amount paid for insurance broker fees	5435
Additional information about fees paid to insurance broker	NON-MONETARY/SUPPLEMENTAL COMP. ADMIN FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	1090
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,778
Total amount of fees paid to insurance company	USD $4,986
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $152,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,778
Amount paid for insurance broker fees	4986
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	398
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,327
Total amount of fees paid to insurance company	USD $6,745
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $215,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,327
Amount paid for insurance broker fees	6745
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	1040
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,316
Total amount of fees paid to insurance company	USD $4,156
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,316
Amount paid for insurance broker fees	4156
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1793
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57,579
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,579
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	501
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,686
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,686
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GUG0AA0W

Policy instance

Insurance contract or identification number	GUG0AA0W
Number of Individuals Covered	1039
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,670
Total amount of fees paid to insurance company	USD $7,637
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,670
Amount paid for insurance broker fees	7637
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

T66BA-P-031398

Policy instance

Insurance contract or identification number	T66BA-P-031398
Number of Individuals Covered	500
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,625
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,625
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	354
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,092
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $184,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,092
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	927
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,399
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $114,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,399
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	500
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,911
Total amount of fees paid to insurance company	USD $10,690
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $259,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,911
Amount paid for insurance broker fees	10690
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	1625
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $54,698
Welfare Benefit Premiums Paid to Carrier	USD $610,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,698
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	347
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,835
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,835
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	870
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,895
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,895
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

FV1076

Policy instance

Insurance contract or identification number	FV1076
Number of Individuals Covered	41
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,446
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,958
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	365
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,147
Total amount of fees paid to insurance company	USD $9,072
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $189,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,147
Amount paid for insurance broker fees	9072
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	746
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $46,849
Welfare Benefit Premiums Paid to Carrier	USD $518,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,849
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	863
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,856
Total amount of fees paid to insurance company	USD $3,921
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $85,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,856
Amount paid for insurance broker fees	3921
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	923
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,379
Total amount of fees paid to insurance company	USD $5,247
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $112,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,379
Amount paid for insurance broker fees	5247
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	460
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,842
Total amount of fees paid to insurance company	USD $9,885
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $247,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,842
Amount paid for insurance broker fees	9885
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30043118

Policy instance

Insurance contract or identification number	30043118
Number of Individuals Covered	272
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,661
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,661
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	455
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,294
Total amount of fees paid to insurance company	USD $9,859
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $221,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,294
Amount paid for insurance broker fees	9859
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	916
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,329
Total amount of fees paid to insurance company	USD $5,832
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $107,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,329
Amount paid for insurance broker fees	5832
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	379
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,120
Total amount of fees paid to insurance company	USD $10,062
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $186,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,120
Amount paid for insurance broker fees	10062
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	854
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,809
Total amount of fees paid to insurance company	USD $4,326
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,809
Amount paid for insurance broker fees	4326
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

FV1076

Policy instance

Insurance contract or identification number	FV1076
Number of Individuals Covered	54
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,403
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $70,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,343
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	836
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $37,516
Welfare Benefit Premiums Paid to Carrier	USD $416,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,516
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	442
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,328
Total amount of fees paid to insurance company	USD $9,907
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $220,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,328
Amount paid for insurance broker fees	9907
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	905
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,918
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $106,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,918
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	387
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $12,277
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,277
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	843
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,509
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,509
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	826
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $40,408
Welfare Benefit Premiums Paid to Carrier	USD $444,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,408
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

FV1076

Policy instance

Insurance contract or identification number	FV1076
Number of Individuals Covered	83
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $16,104
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $84,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,613
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

FV1076

Policy instance

Insurance contract or identification number	FV1076
Number of Individuals Covered	96
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $15,676
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $73,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	436
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,418
Total amount of fees paid to insurance company	USD $8,107
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $221,895
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

715313

Policy instance

Insurance contract or identification number	715313
Number of Individuals Covered	821
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $34,527
Welfare Benefit Premiums Paid to Carrier	USD $379,990
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

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	853
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,156
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,865
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

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	403
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $13,541
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,441
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

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	910
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,763
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $103,236
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

GVTL0AA0W

Policy instance

Insurance contract or identification number	GVTL0AA0W
Number of Individuals Covered	419
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $16,096
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,096
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00315543

Policy instance

Insurance contract or identification number	00315543
Number of Individuals Covered	433
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,171
Total amount of fees paid to insurance company	USD $9,897
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $209,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,154
Amount paid for insurance broker fees	9897
Additional information about fees paid to insurance broker	BONUS COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WOODY FINANCIAL GROUP INC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

FV1076

Policy instance

Insurance contract or identification number	FV1076
Number of Individuals Covered	76
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $14,715
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $70,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,778
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLTD0AA0W

Policy instance

Insurance contract or identification number	GLTD0AA0W
Number of Individuals Covered	871
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,462
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,462
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

GLUG0AA0W

Policy instance

Insurance contract or identification number	GLUG0AA0W
Number of Individuals Covered	928
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,508
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $100,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,508
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	MFA OIL COMPANY
Employer identification number (EIN):	430415115
NAIC Classification:	424700

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	1983233