BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	503

BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

BURNS & MCDONNELL, INC. has sponsored the creation of one or more 401k plans.

Company Name:	BURNS & MCDONNELL, INC.
Employer identification number (EIN):	431393692
NAIC Classification:	541330
NAIC Description:	Engineering Services

Additional information about BURNS & MCDONNELL, INC.

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1996-06-12
Company Identification Number:	0011036406
Legal Registered Office Address:	9400 WARD PKWY ATTN: TAX DEPT KANSAS CITY United States of America (USA) 64114

More information about BURNS & MCDONNELL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01
503	2021-01-01
503	2020-01-01
503	2019-01-01
503	2018-01-01
503	2018-01-01
503	2017-01-01	ROBERT G. JONES
503	2016-01-01	ROBERT G. JONES
503	2015-01-01	ROBERT G. JONES
503	2015-01-01	ROBERT G. JONES
503	2014-01-01	ROBERT G. JONES		ROBERT G. JONES	2015-10-13
503	2014-01-01	ROBERT G. JONES		ROBERT G. JONES	2015-10-13
503	2013-01-01	ROBERT G. JONES
503	2012-01-01	ROBERT G. JONES
503	2011-01-01	ROBERT JONES
503	2010-01-01	ROBERT JONES
503	2009-01-01	ROBERT G. JONES		ROBERT G. JONES	2010-10-12
503	2009-01-01	ROBERT G. JONES		ROBERT G. JONES	2010-10-12

Plan Statistics for BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN

Measure	Date	Value
2022: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	7,586
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	7,677
Number of retired or separated participants receiving benefits	2022-01-01	8
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	7,685
2021: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	6,925
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	7,581
Number of retired or separated participants receiving benefits	2021-01-01	375
Total of all active and inactive participants	2021-01-01	7,956
Total participants	2021-01-01	7,956
2020: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	6,893
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	6,701
Number of retired or separated participants receiving benefits	2020-01-01	224
Total of all active and inactive participants	2020-01-01	6,925
Total participants	2020-01-01	6,925
2019: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	5,816
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	6,739
Number of retired or separated participants receiving benefits	2019-01-01	154
Total of all active and inactive participants	2019-01-01	6,893
Total participants	2019-01-01	6,893
2018: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5,007
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5,681
Number of retired or separated participants receiving benefits	2018-01-01	135
Total of all active and inactive participants	2018-01-01	5,816
Total participants	2018-01-01	5,816
2017: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	4,827
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	4,906
Number of retired or separated participants receiving benefits	2017-01-01	101
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	5,007
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	5,007
2016: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	4,640
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	4,730
Number of retired or separated participants receiving benefits	2016-01-01	97
Total of all active and inactive participants	2016-01-01	4,827
Total participants	2016-01-01	4,827
2015: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4,865
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	4,545
Number of retired or separated participants receiving benefits	2015-01-01	95
Total of all active and inactive participants	2015-01-01	4,640
Total participants	2015-01-01	4,640
2014: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4,230
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4,730
Number of retired or separated participants receiving benefits	2014-01-01	135
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	4,865
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4,865
2013: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,799
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	4,121
Number of retired or separated participants receiving benefits	2013-01-01	109
Total of all active and inactive participants	2013-01-01	4,230
Total participants	2013-01-01	4,230
2012: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3,446
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3,691
Number of retired or separated participants receiving benefits	2012-01-01	108
Total of all active and inactive participants	2012-01-01	3,799
Total participants	2012-01-01	3,799
2011: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,967
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3,286
Number of retired or separated participants receiving benefits	2011-01-01	160
Total of all active and inactive participants	2011-01-01	3,446
Total participants	2011-01-01	3,446
2010: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2,974
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,967
Total of all active and inactive participants	2010-01-01	2,967
Total participants	2010-01-01	2,967
2009: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,727
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,974
Total of all active and inactive participants	2009-01-01	2,974
Total participants	2009-01-01	2,974

Financial Data on BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN

Measure	Date	Value
2014 : BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$5,945,776
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$5,030,242
Total income from all sources (including contributions)	2014-12-31	$37,647,217
Total of all expenses incurred	2014-12-31	$46,218,345
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$43,030,075
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$37,646,831
Value of total assets at end of year	2014-12-31	$0
Value of total assets at beginning of year	2014-12-31	$7,655,594
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,188,270
Total interest from all sources	2014-12-31	$386
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$3,188,270
Was this plan covered by a fidelity bond	2014-12-31	No
Value of fidelity bond cover	2014-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$14,279,503
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$675
Liabilities. Value of operating payables at end of year	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$132,084
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$10,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-8,571,128
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$-5,945,776
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,625,352
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$7,644,119
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$7,644,119
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$386
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$9,281,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$23,367,328
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$33,748,386
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$5,945,776
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$4,898,158
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	BKD, LLP
Accountancy firm EIN	2014-12-31	440160260
2013 : BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$5,030,242
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$4,593,187
Total income from all sources (including contributions)	2013-12-31	$42,973,867
Total of all expenses incurred	2013-12-31	$39,858,820
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$37,597,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$42,973,530
Value of total assets at end of year	2013-12-31	$7,655,594
Value of total assets at beginning of year	2013-12-31	$4,103,492
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$2,260,898
Total interest from all sources	2013-12-31	$337
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$2,260,898
Was this plan covered by a fidelity bond	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$12,258,461
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$675
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$3,492
Liabilities. Value of operating payables at end of year	2013-12-31	$132,084
Liabilities. Value of operating payables at beginning of year	2013-12-31	$106,834
Total non interest bearing cash at end of year	2013-12-31	$10,800
Total non interest bearing cash at beginning of year	2013-12-31	$10,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$3,115,047
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,625,352
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$-489,695
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$7,644,119
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$4,089,200
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$4,089,200
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$337
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$8,079,313
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$30,715,069
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$29,518,609
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$4,898,158
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$4,486,353
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	BKD, LLP
Accountancy firm EIN	2013-12-31	440160260
2012 : BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$4,593,187
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$94,806
Total income from all sources (including contributions)	2012-12-31	$32,567,688
Total of all expenses incurred	2012-12-31	$36,893,253
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$34,904,972
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$32,567,441
Value of total assets at end of year	2012-12-31	$4,103,492
Value of total assets at beginning of year	2012-12-31	$3,930,676
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,988,281
Total interest from all sources	2012-12-31	$247
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$1,988,281
Was this plan covered by a fidelity bond	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$11,754,948
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$3,492
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$16,044
Liabilities. Value of operating payables at end of year	2012-12-31	$106,834
Liabilities. Value of operating payables at beginning of year	2012-12-31	$94,806
Total non interest bearing cash at end of year	2012-12-31	$10,800
Total non interest bearing cash at beginning of year	2012-12-31	$10,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-4,325,565
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$-489,695
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,835,870
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$4,089,200
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$3,903,832
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$3,903,832
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$247
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$6,668,483
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$20,812,493
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$28,236,489
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$4,486,353
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	DELOITTE & TOUCHE
Accountancy firm EIN	2012-12-31	133891517
2011 : BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$94,806
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$85,695
Total income from all sources (including contributions)	2011-12-31	$28,556,330
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$28,054,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$26,405,909
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$28,556,123
Value of total assets at end of year	2011-12-31	$3,930,676
Value of total assets at beginning of year	2011-12-31	$3,419,257
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,648,113
Total interest from all sources	2011-12-31	$207
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$1,648,113
Was this plan covered by a fidelity bond	2011-12-31	No
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$10,732,739
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$16,044
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$12,485
Liabilities. Value of operating payables at end of year	2011-12-31	$94,806
Liabilities. Value of operating payables at beginning of year	2011-12-31	$85,695
Total non interest bearing cash at end of year	2011-12-31	$10,800
Total non interest bearing cash at beginning of year	2011-12-31	$10,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$502,308
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,835,870
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,333,562
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$3,903,832
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$3,395,972
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$3,395,972
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$207
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$5,316,257
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$17,823,384
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$21,089,652
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	DELOITTE & TOUCHE
Accountancy firm EIN	2011-12-31	133891517
2010 : BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$85,695
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$81,065
Total income from all sources (including contributions)	2010-12-31	$26,071,024
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$25,779,233
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$24,247,759
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$26,070,785
Value of total assets at end of year	2010-12-31	$3,419,257
Value of total assets at beginning of year	2010-12-31	$3,122,836
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,531,474
Total interest from all sources	2010-12-31	$239
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$1,531,474
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$9,321,515
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$12,485
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$10,111
Liabilities. Value of operating payables at end of year	2010-12-31	$85,695
Liabilities. Value of operating payables at beginning of year	2010-12-31	$81,065
Total non interest bearing cash at end of year	2010-12-31	$10,800
Total non interest bearing cash at beginning of year	2010-12-31	$10,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$291,791
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,333,562
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,041,771
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$3,395,972
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$3,101,925
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$3,101,925
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$239
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$4,934,918
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$16,749,270
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$19,312,841
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	DELOITTE & TOUCHE
Accountancy firm EIN	2010-12-31	133891517

Form 5500 Responses for BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN

2022: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	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 - Trust	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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 – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS 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 – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BURNS & MCDONNELL, INC. HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	6
Insurance contract or identification number 0161788 Number of Individuals Covered 15948 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of fees paid to insurance company USD $116,296 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,903,598 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 116296 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 8854 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $44,032 Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $293,545 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,032 Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 2189 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $60,296 Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $172,275 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,455 Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number	71 5956M
Policy instance	3
Insurance contract or identification number 71 5956M Number of Individuals Covered 18533 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Welfare Benefit Premiums Paid to Carrier USD $5,160,724 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-21
Policy instance	4
Insurance contract or identification number 4EL-6636-21 Number of Individuals Covered 6299 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $2,823 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,822 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,823 Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-21
Policy instance	5
Insurance contract or identification number 4EL-8012-21 Number of Individuals Covered 95 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $54,275 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $542,751 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $54,275 Insurance broker organization code? 3
THE NORTH RIVER INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 44520 )
Policy contract number	FRC8743
Policy instance	13
Insurance contract or identification number FRC8743 Number of Individuals Covered 40 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $100 Other welfare benefits provided ACCIDENT Welfare Benefit Premiums Paid to Carrier USD $996 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $100 Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	7
Insurance contract or identification number 0162139 Number of Individuals Covered 2727 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $70,018 Total amount of fees paid to insurance company USD $6,056 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $358,789 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $70,018 Amount paid for insurance broker fees 6056 Additional information about fees paid to insurance broker NON-MONETARY/SUPPLEMENTAL COMP. MARKETING FEES Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	8
Insurance contract or identification number 0162138 Number of Individuals Covered 3615 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $109,168 Total amount of fees paid to insurance company USD $9,317 Other welfare benefits provided CRITICAL ILLNESS Welfare Benefit Premiums Paid to Carrier USD $564,028 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $109,168 Amount paid for insurance broker fees 9317 Additional information about fees paid to insurance broker NON-MONETARY/SUPPLEMENTAL COMP. MARKETING FEES Insurance broker organization code? 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	901726
Policy instance	9
Insurance contract or identification number 901726 Number of Individuals Covered 6299 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $279,767 Total amount of fees paid to insurance company USD $5,939 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,964,253 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $279,767 Amount paid for insurance broker fees 5939 Additional information about fees paid to insurance broker BONUSES Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9901891
Policy instance	10
Insurance contract or identification number 9901891 Number of Individuals Covered 1652 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $34,484 Total amount of fees paid to insurance company USD $10,795 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $342,073 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,484 Amount paid for insurance broker fees 1483 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION MARKETING FEE Insurance broker organization code? 3
DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 )
Policy contract number	0000004612
Policy instance	11
Insurance contract or identification number 0000004612 Number of Individuals Covered 25 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $3,655 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,554 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,655 Insurance broker organization code? 3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number	FRC8743
Policy instance	12
Insurance contract or identification number FRC8743 Number of Individuals Covered 40 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $7,255 Total amount of fees paid to insurance company USD $7,569 Welfare Benefit Premiums Paid to Carrier USD $74,500 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,255 Amount paid for insurance broker fees 2170 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-20
Policy instance	5
Insurance contract or identification number 4EL-8012-20 Number of Individuals Covered 73 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $31,439 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $314,392 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $31,439 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVE LIFE INSURANCE COMPANY Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-20
Policy instance	4
Insurance contract or identification number 4EL-6636-20 Insurance policy start date 2021-07-01 Insurance policy end date 2022-06-30 Total amount of commissions paid to insurance broker USD $3,799 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $25,325 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,799 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVE LIFE INSURANCE COMPANY Insurance broker organization code? 3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	3
Insurance contract or identification number 28549000 Number of Individuals Covered 16553 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $138,000 Total amount of fees paid to insurance company USD $250,000 Health 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 $138,000 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 2000 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $54,166 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $154,760 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,952 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 7602 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $40,517 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $270,113 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $40,517 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	6
Insurance contract or identification number 0161788 Number of Individuals Covered 14237 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of fees paid to insurance company USD $82,960 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,228,807 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 82960 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	7
Insurance contract or identification number 0162139 Number of Individuals Covered 2364 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $65,643 Total amount of fees paid to insurance company USD $4,155 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $317,733 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $65,643 Amount paid for insurance broker fees 4155 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	8
Insurance contract or identification number 0162138 Number of Individuals Covered 3165 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $100,693 Total amount of fees paid to insurance company USD $6,314 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $480,477 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $100,693 Amount paid for insurance broker fees 6314 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	901726
Policy instance	9
Insurance contract or identification number 901726 Number of Individuals Covered 7581 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $271,516 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $271,516 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO SUN LIFE Insurance broker organization code? 3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	905840
Policy instance	10
Insurance contract or identification number 905840 Number of Individuals Covered 72 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES FOR SUN LIF Insurance broker organization code? 3
DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 )
Policy contract number	0000004612
Policy instance	12
Insurance contract or identification number 0000004612 Number of Individuals Covered 21 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $3,148 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $31,477 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,148 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO DELAWARE Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9901891
Policy instance	11
Insurance contract or identification number 9901891 Number of Individuals Covered 1401 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $29,266 Total amount of fees paid to insurance company USD $3,678 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $282,095 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,266 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METLIFE Insurance broker organization code? 3 Amount paid for insurance broker fees 3607
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-19
Policy instance	5
Insurance contract or identification number 4EL-8012-19 Number of Individuals Covered 68 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $32,681 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $326,805 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,681 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVE LIFE INSURANCE COMPANY Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-19
Policy instance	4
Insurance contract or identification number 4EL-6636-19 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $4,236 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,239 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,236 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVE LIFE INSURANCE COMPANY Insurance broker organization code? 3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	3
Insurance contract or identification number 28549000 Number of Individuals Covered 15297 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $138,000 Total amount of fees paid to insurance company USD $250,000 Health 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 $138,000 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 1910 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $53,878 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $153,936 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $30,787 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 6558 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $37,720 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $251,466 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $37,720 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	6
Insurance contract or identification number 0161788 Number of Individuals Covered 13086 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of fees paid to insurance company USD $76,063 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,443,816 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 76063 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	7
Insurance contract or identification number 0162139 Number of Individuals Covered 2120 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $56,981 Total amount of fees paid to insurance company USD $4,341 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $300,597 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,981 Amount paid for insurance broker fees 4341 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	901726
Policy instance	9
Insurance contract or identification number 901726 Number of Individuals Covered 6701 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $315,944 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $315,944 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO SUN LIFE Insurance broker organization code? 3
DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 )
Policy contract number	0000004612
Policy instance	12
Insurance contract or identification number 0000004612 Number of Individuals Covered 12 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,644 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $16,441 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,644 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO DELAWARE Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9901891
Policy instance	11
Insurance contract or identification number 9901891 Number of Individuals Covered 1215 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $26,860 Total amount of fees paid to insurance company USD $3,081 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $268,182 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,860 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METLIFE Insurance broker organization code? 3 Amount paid for insurance broker fees 3077
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	905840
Policy instance	10
Insurance contract or identification number 905840 Number of Individuals Covered 50 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES FOR SUN LIF Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	8
Insurance contract or identification number 0162138 Number of Individuals Covered 2834 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $80,947 Total amount of fees paid to insurance company USD $6,132 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $438,791 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $80,947 Amount paid for insurance broker fees 6132 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	905840
Policy instance	11
Insurance contract or identification number 905840 Number of Individuals Covered 51 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES FOR SUN LIF Insurance broker organization code? 3
AMERITAS LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	901726
Policy instance	10
Insurance contract or identification number 901726 Number of Individuals Covered 6739 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $261,124 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $261,124 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO SUN LIFE Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	9
Insurance contract or identification number 0162138 Number of Individuals Covered 1688 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $79,944 Total amount of fees paid to insurance company USD $5,532 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $409,146 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $79,944 Amount paid for insurance broker fees 5532 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	7
Insurance contract or identification number 0161788 Number of Individuals Covered 12959 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of fees paid to insurance company USD $73,296 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,452,452 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 73296 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 6592 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $68,288 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $227,627 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,144 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-18
Policy instance	5
Insurance contract or identification number 4EL-8012-18 Number of Individuals Covered 101 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $47,324 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $473,241 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $47,324 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 2013 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $42,456 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $121,302 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,261 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	3
Insurance contract or identification number 28549000 Number of Individuals Covered 15243 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $141,000 Total amount of fees paid to insurance company USD $250,182 Health 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 $141,000 Amount paid for insurance broker fees 250182 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-18
Policy instance	4
Insurance contract or identification number 4EL-6636-18 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $4,236 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,239 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,236 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	8
Insurance contract or identification number 0162139 Number of Individuals Covered 2178 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $56,454 Total amount of fees paid to insurance company USD $3,929 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $288,062 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,454 Amount paid for insurance broker fees 3929 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90557 )
Policy contract number	CLPEX01012
Policy instance	6
Insurance contract or identification number CLPEX01012 Number of Individuals Covered 25 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,316 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $23,159 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,316 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO ZURICH AMERICAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9901891
Policy instance	12
Insurance contract or identification number 9901891 Number of Individuals Covered 1171 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $24,205 Total amount of fees paid to insurance company USD $2,762 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $222,536 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,205 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METLIFE Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 5940 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $74,134 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $247,114 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $37,067 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
AMERITAS LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	901726
Policy instance	11
Insurance contract or identification number 901726 Number of Individuals Covered 5935 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $211,274 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $211,274 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO SUN LIFE Insurance broker organization code? 3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	905840
Policy instance	10
Insurance contract or identification number 905840 Number of Individuals Covered 58 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,725 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO SUN LIFE Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	9
Insurance contract or identification number 0162138 Number of Individuals Covered 2364 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $77,587 Total amount of fees paid to insurance company USD $9,195 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $368,054 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $77,587 Amount paid for insurance broker fees 9195 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	8
Insurance contract or identification number 0162139 Number of Individuals Covered 1942 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $54,232 Total amount of fees paid to insurance company USD $6,465 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $256,790 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $54,232 Amount paid for insurance broker fees 6465 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90557 )
Policy contract number	CLPEX01012
Policy instance	6
Insurance contract or identification number CLPEX01012 Number of Individuals Covered 26 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $4,675 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $46,303 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,675 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO ZURICH AMERICAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-17
Policy instance	5
Insurance contract or identification number 4EL-8012-17 Number of Individuals Covered 102 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $55,307 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $553,070 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,307 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker organization code? 3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	3
Insurance contract or identification number 28549000 Number of Individuals Covered 13725 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $141,000 Total amount of fees paid to insurance company USD $250,161 Health 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 $141,000 Amount paid for insurance broker fees 250161 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 1890 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $41,878 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $119,651 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,930 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-17
Policy instance	4
Insurance contract or identification number 4EL-6636-17 Insurance policy start date 2017-07-01 Insurance policy end date 2018-06-30 Total amount of commissions paid to insurance broker USD $5,134 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,228 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,134 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	7
Insurance contract or identification number 0161788 Number of Individuals Covered 11597 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $55,714 Total amount of fees paid to insurance company USD $121,398 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,891,403 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,714 Amount paid for insurance broker fees 121398 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	1
Insurance contract or identification number 64100437 Number of Individuals Covered 5476 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $64,634 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $215,446 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,317 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	2
Insurance contract or identification number 64100438 Number of Individuals Covered 1622 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $33,556 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $95,873 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,381 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	3
Insurance contract or identification number 28549000 Number of Individuals Covered 12653 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $141,000 Total amount of fees paid to insurance company USD $250,000 Health 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 $141,000 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT COMPANY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00492281
Policy instance	4
Insurance contract or identification number 00492281 Number of Individuals Covered 5447 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $248,422 Total amount of fees paid to insurance company USD $37,099 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $248,422 Amount paid for insurance broker fees 37099 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO GUARDIAN LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-6636-16
Policy instance	5
Insurance contract or identification number 4EL-6636-16 Insurance policy start date 2016-10-01 Insurance policy end date 2017-06-30 Total amount of commissions paid to insurance broker USD $3,672 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $24,482 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,672 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90557 )
Policy contract number	CLPEX01012
Policy instance	6
Insurance contract or identification number CLPEX01012 Number of Individuals Covered 29 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $4,419 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $40,610 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,419 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO ZURICH AMERICAN LIFE INSURANCE COMPANY Insurance broker name ROBERT R. SWEATT III
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0161788
Policy instance	7
Insurance contract or identification number 0161788 Number of Individuals Covered 10630 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $199,822 Total amount of fees paid to insurance company USD $63,749 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,404,794 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $199,822 Amount paid for insurance broker fees 63749 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162138
Policy instance	8
Insurance contract or identification number 0162138 Number of Individuals Covered 2307 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $58,070 Total amount of fees paid to insurance company USD $4,608 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $345,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $58,070 Amount paid for insurance broker fees 4608 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0162139
Policy instance	9
Insurance contract or identification number 0162139 Number of Individuals Covered 2194 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $39,084 Total amount of fees paid to insurance company USD $3,116 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $229,887 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,084 Amount paid for insurance broker fees 3116 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES FOR METROPOLITAN LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-8012-16
Policy instance	10
Insurance contract or identification number 4EL-8012-16 Number of Individuals Covered 50 Insurance policy start date 2016-07-01 Insurance policy end date 2017-06-30 Total amount of commissions paid to insurance broker USD $27,414 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $274,136 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,414 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY Insurance broker name LOCKTON COMPANIES, LLC
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90557 )
Policy contract number	CLPEX01012
Policy instance	9
Insurance contract or identification number CLPEX01012 Number of Individuals Covered 12 Insurance policy start date 2015-10-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $661 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,608 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $661 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO ZURICH AMERICAN LIFE INSURANCE COMPANY Insurance broker name ROBERT R. SWEATT
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-7385-13
Policy instance	8
Insurance contract or identification number 4EL-7385-13 Number of Individuals Covered 2 Insurance policy start date 2014-10-01 Insurance policy end date 2015-09-30 Total amount of commissions paid to insurance broker USD $1,118 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,184 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,118 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FOUR EVER LIFE INSURANCE COMPANY 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	00492281
Policy instance	7
Insurance contract or identification number 00492281 Number of Individuals Covered 5026 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $243,482 Total amount of fees paid to insurance company USD $76,841 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $163,812 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO GUARDIAN LIFE INSURANCE COMPANY Insurance broker organization code? 3 Amount paid for insurance broker fees 76841 Insurance broker name LOCKTON COMPANIES LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	5
Insurance contract or identification number 28549000 Number of Individuals Covered 11484 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $112,956 Total amount of fees paid to insurance company USD $250,000 Health 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 $112,956 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT COMPANY
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	4
Insurance contract or identification number 64100438 Number of Individuals Covered 1204 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $18,083 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $51,666 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,750 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	3
Insurance contract or identification number 64100437 Number of Individuals Covered 5040 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $58,618 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $195,394 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,309 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO FEDERAL INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number	010350329
Policy instance	1
Insurance contract or identification number 010350329 Number of Individuals Covered 9385 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $181,924 Total amount of fees paid to insurance company USD $10,000 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,638,481 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $181,924 Amount paid for insurance broker fees 10000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO AMERITAS LIFE INSURANCE COMPANY Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number	12197829
Policy instance	2
Insurance contract or identification number 12197829 Number of Individuals Covered 2619 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $27,256 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 $27,256 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO VSP SERVICE PLAN Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	5
Insurance contract or identification number 28549000 Number of Individuals Covered 10613 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $97,200 Total amount of fees paid to insurance company USD $250,000 Health 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 $97,200 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT COMPANY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00492281
Policy instance	7
Insurance contract or identification number 00492281 Number of Individuals Covered 4544 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $191,913 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability 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 $411 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	4
Insurance contract or identification number 64100438 Number of Individuals Covered 438 Insurance policy start date 2014-01-01 Insurance policy end date 2015-01-01 Total amount of commissions paid to insurance broker USD $14,668 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $41,909 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,286 Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number	12197829
Policy instance	2
Insurance contract or identification number 12197829 Number of Individuals Covered 4321 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $23,722 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 $23,722 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number	010350329
Policy instance	1
Insurance contract or identification number 010350329 Number of Individuals Covered 8588 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $168,581 Total amount of fees paid to insurance company USD $51,906 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,371,615 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $168,581 Amount paid for insurance broker fees 51906 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO AMERITAS Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number	4EL-7385-13
Policy instance	8
Insurance contract or identification number 4EL-7385-13 Number of Individuals Covered 3 Insurance policy start date 2013-10-01 Insurance policy end date 2014-09-30 Total amount of commissions paid to insurance broker USD $2,142 Welfare Benefit Premiums Paid to Carrier USD $21,422 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,142 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	3
Insurance contract or identification number 64100437 Number of Individuals Covered 4721 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $52,114 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $173,713 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,057 Insurance broker organization code? 3 Insurance broker name REUBEN WARNER ASSOCIATES, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	5
Insurance contract or identification number 64100438 Number of Individuals Covered 602 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $7,092 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,151 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,092 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	4
Insurance contract or identification number 64100437 Number of Individuals Covered 4092 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $38,464 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $191,015 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,464 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES-LOCKTON INSURANCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number	12197829
Policy instance	3
Insurance contract or identification number 12197829 Number of Individuals Covered 3819 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $20,662 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 $20,662 Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT CO.
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number	010350329
Policy instance	2
Insurance contract or identification number 010350329 Number of Individuals Covered 7378 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $117,443 Total amount of fees paid to insurance company USD $25,324 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,348,857 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $117,443 Amount paid for insurance broker fees 25324 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO AMERITAS Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	100532
Policy instance	1
Insurance contract or identification number 100532 Number of Individuals Covered 7657 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $12,402 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,493,977 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,402 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	6
Insurance contract or identification number 28549000 Number of Individuals Covered 9326 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $87,840 Total amount of fees paid to insurance company USD $250,000 Health 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 $87,840 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT COMPANY
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	6
Insurance contract or identification number 28549000 Number of Individuals Covered 8190 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $75,408 Total amount of fees paid to insurance company USD $250,000 Health 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 $75,408 Amount paid for insurance broker fees 250000 Additional information about fees paid to insurance broker ADMINISTRATIVE SERVICES TO BCBSKC Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT COMPANY
AMERITAS LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	64100438
Policy instance	5
Insurance contract or identification number 64100438 Number of Individuals Covered 539 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $3,394 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $17,635 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,394 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	4
Insurance contract or identification number 64100437 Number of Individuals Covered 3588 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $26,297 Welfare Benefit Premiums Paid to Carrier USD $150,271 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,297 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES-LOCKTON INSURANCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number	12197829
Policy instance	3
Insurance contract or identification number 12197829 Number of Individuals Covered 3319 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $17,275 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 $17,275 Insurance broker organization code? 3 Insurance broker name LOCKTON BENEFIT CO.
AMERITAS LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	010350329
Policy instance	2
Insurance contract or identification number 010350329 Number of Individuals Covered 5658 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $103,810 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,856,193 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $103,810 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	100532
Policy instance	1
Insurance contract or identification number 100532 Number of Individuals Covered 6780 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $11,643 Life Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,225,931 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,643 Insurance broker organization code? 3 Insurance broker name LOCKTON COMPANIES LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	1
Insurance contract or identification number 28549000 Number of Individuals Covered 7448 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $75,408 Total amount of fees paid to insurance company USD $250,000 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HTH WORLDWIDE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	500802280
Policy instance	2
Insurance contract or identification number 500802280 Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $845 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $11,268 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	12197829
Policy instance	3
Insurance contract or identification number 12197829 Number of Individuals Covered 3007 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $15,515 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	4
Insurance contract or identification number 64100438 Number of Individuals Covered 502 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $4,439 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $27,830 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	5
Insurance contract or identification number 64100437 Number of Individuals Covered 3271 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $21,208 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $132,964 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	100532
Policy instance	6
Insurance contract or identification number 100532 Number of Individuals Covered 6128 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $11,168 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,047,842 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	881642-52-096
Policy instance	7
Insurance contract or identification number 881642-52-096 Number of Individuals Covered 5 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $988 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $7,608 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number	010350329
Policy instance	8
Insurance contract or identification number 010350329 Number of Individuals Covered 4965 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $83,720 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,654,400 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	12197829
Policy instance	7
Insurance contract or identification number 12197829 Number of Individuals Covered 2819 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $13,996 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	100532
Policy instance	6
Insurance contract or identification number 100532 Number of Individuals Covered 5473 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $11,267 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,904,192 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100438
Policy instance	5
Insurance contract or identification number 64100438 Number of Individuals Covered 472 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $3,785 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $25,229 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number	010350329
Policy instance	4
Insurance contract or identification number 010350329 Number of Individuals Covered 4650 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $81,792 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,599,924 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64100437
Policy instance	3
Insurance contract or identification number 64100437 Number of Individuals Covered 2958 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $19,131 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $127,539 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	881642-52-096
Policy instance	2
Insurance contract or identification number 881642-52-096 Number of Individuals Covered 7 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,724 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $27,237 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	28549000
Policy instance	8
Insurance contract or identification number 28549000 Number of Individuals Covered 6851 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $60,420 Total amount of fees paid to insurance company USD $250,000 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No

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