401k Plan data: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN plan

HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

HENDERSEN-WEBB INC has sponsored the creation of one or more 401k plans.

Company Name: HENDERSEN-WEBB INC

Employer identification number (EIN): 521008297

NAIC Classification: 531110
NAIC Description: Lessors of Residential Buildings and Dwellings

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JAMIE LUBLINER 2024-09-23
501 2022-01-01 JAMIE LUBLINER 2023-07-07
501 2021-01-01 PAMELA F. NEWLAND 2022-07-18
501 2020-01-01 PAMELA F. NEWLAND 2021-07-23
501 2019-01-01 PAMELA F. NEWLAND 2020-10-02
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 PAMELA F. NEWLAND
501 2011-01-01 PAMELA F. NEWLAND
501 2009-01-01 PAMELA F. NEWLAND

Plan Statistics for HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2023: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 254
Total of all active and inactive participants 2023-01-01 254
2022: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 227
Total of all active and inactive participants 2022-01-01 227
2021: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 241
Total of all active and inactive participants 2021-01-01 241
2020: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 283
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 243
Total of all active and inactive participants 2020-01-01 243
2019: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 283
Total of all active and inactive participants 2019-01-01 283
2018: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 283
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 286
Total of all active and inactive participants 2018-01-01 286
2017: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 296
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 283
Total of all active and inactive participants 2017-01-01 283
2016: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 289
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 296
Total of all active and inactive participants 2016-01-01 296
2015: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 265
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 289
Total of all active and inactive participants 2015-01-01 289
2014: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 265
Total of all active and inactive participants 2014-01-01 265
2013: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 250
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 358
Total of all active and inactive participants 2013-01-01 358
2012: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 250
Total of all active and inactive participants 2012-01-01 250
2011: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 352
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 360
Total of all active and inactive participants 2011-01-01 360
2009: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 385
Total of all active and inactive participants 2009-01-01 385

Measure	Date	Value
2023: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	254
Total of all active and inactive participants	2023-01-01	254
2022: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	227
Total of all active and inactive participants	2022-01-01	227
2021: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	241
Total of all active and inactive participants	2021-01-01	241
2020: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	283
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	243
Total of all active and inactive participants	2020-01-01	243
2019: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	283
Total of all active and inactive participants	2019-01-01	283
2018: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	283
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	286
Total of all active and inactive participants	2018-01-01	286
2017: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	296
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	283
Total of all active and inactive participants	2017-01-01	283
2016: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	289
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	296
Total of all active and inactive participants	2016-01-01	296
2015: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	265
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	289
Total of all active and inactive participants	2015-01-01	289
2014: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	265
Total of all active and inactive participants	2014-01-01	265
2013: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	250
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	358
Total of all active and inactive participants	2013-01-01	358
2012: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	250
Total of all active and inactive participants	2012-01-01	250
2011: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	352
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	360
Total of all active and inactive participants	2011-01-01	360
2009: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	385
Total of all active and inactive participants	2009-01-01	385

Form 5500 Responses for HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN

2023: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: HENDERSEN WEBB 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: HENDERSEN WEBB 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: HENDERSEN WEBB 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: HENDERSEN WEBB 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: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: HENDERSEN WEBB 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: HENDERSEN WEBB 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: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: HENDERSEN WEBB 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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HENDERSEN WEBB 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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: HENDERSEN WEBB HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

2KRA

Policy instance

Insurance contract or identification number	2KRA
Number of Individuals Covered	281
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $2,329
Total amount of fees paid to insurance company	USD $83,989
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,794,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	254
Insurance policy start date	2022-03-01
Insurance policy end date	2023-03-01
Total amount of commissions paid to insurance broker	USD $4,190
Total amount of fees paid to insurance company	USD $1,733
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	254
Insurance policy start date	2022-03-01
Insurance policy end date	2023-03-01
Total amount of commissions paid to insurance broker	USD $289
Total amount of fees paid to insurance company	USD $117
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	223
Insurance policy start date	2022-03-01
Insurance policy end date	2023-03-01
Total amount of commissions paid to insurance broker	USD $2,832
Total amount of fees paid to insurance company	USD $1,188
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	223
Insurance policy start date	2022-03-01
Insurance policy end date	2023-03-01
Total amount of commissions paid to insurance broker	USD $2,612
Total amount of fees paid to insurance company	USD $1,158
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	203
Insurance policy start date	2021-03-01
Insurance policy end date	2022-03-01
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $1,041
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $425
Amount paid for insurance broker fees	1041
Additional information about fees paid to insurance broker	SALES & SERVICES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	203
Insurance policy start date	2021-03-01
Insurance policy end date	2022-03-01
Total amount of commissions paid to insurance broker	USD $463
Total amount of fees paid to insurance company	USD $1,152
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $463
Amount paid for insurance broker fees	1152
Additional information about fees paid to insurance broker	SALES & SERVICES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	227
Insurance policy start date	2021-03-01
Insurance policy end date	2022-03-01
Total amount of commissions paid to insurance broker	USD $47
Total amount of fees paid to insurance company	USD $110
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $890
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
Amount paid for insurance broker fees	110
Additional information about fees paid to insurance broker	SALES & SERVICES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	227
Insurance policy start date	2021-03-01
Insurance policy end date	2022-03-01
Total amount of commissions paid to insurance broker	USD $689
Total amount of fees paid to insurance company	USD $1,613
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $689
Amount paid for insurance broker fees	1613
Additional information about fees paid to insurance broker	SALES & SERVICES
Insurance broker organization code?	3

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

2KRA

Policy instance

Insurance contract or identification number	2KRA
Number of Individuals Covered	290
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $7,099
Total amount of fees paid to insurance company	USD $64,466
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,553,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,099
Amount paid for insurance broker fees	64466
Additional information about fees paid to insurance broker	NEW BUSINESS BONUSPRODUCER SERVICE FEE
Insurance broker organization code?	3

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

Policy contract number

914021

Policy instance

Insurance contract or identification number	914021
Number of Individuals Covered	356
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $16,124
Total amount of fees paid to insurance company	USD $83,959
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,706,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,040
Amount paid for insurance broker fees	81197
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	241
Insurance policy start date	2020-03-01
Insurance policy end date	2021-03-01
Total amount of commissions paid to insurance broker	USD $4,133
Total amount of fees paid to insurance company	USD $854
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,133
Amount paid for insurance broker fees	854
Additional information about fees paid to insurance broker	SALES AND SERVICES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	241
Insurance policy start date	2020-03-01
Insurance policy end date	2021-03-01
Total amount of commissions paid to insurance broker	USD $284
Total amount of fees paid to insurance company	USD $63
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $284
Amount paid for insurance broker fees	63
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	230
Insurance policy start date	2020-03-01
Insurance policy end date	2021-03-01
Total amount of commissions paid to insurance broker	USD $2,978
Total amount of fees paid to insurance company	USD $633
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,978
Amount paid for insurance broker fees	633
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	230
Insurance policy start date	2020-03-01
Insurance policy end date	2021-03-01
Total amount of commissions paid to insurance broker	USD $2,719
Total amount of fees paid to insurance company	USD $557
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,719
Amount paid for insurance broker fees	557
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	228
Insurance policy start date	2019-03-01
Insurance policy end date	2020-03-01
Total amount of commissions paid to insurance broker	USD $2,824
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,824
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	228
Insurance policy start date	2019-03-01
Insurance policy end date	2020-03-01
Total amount of commissions paid to insurance broker	USD $3,131
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,131
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	243
Insurance policy start date	2019-03-01
Insurance policy end date	2020-03-01
Total amount of commissions paid to insurance broker	USD $309
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $309
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	243
Insurance policy start date	2019-03-01
Insurance policy end date	2020-03-01
Total amount of commissions paid to insurance broker	USD $4,544
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,544
Insurance broker organization code?	3

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

Policy contract number

914021

Policy instance

Insurance contract or identification number	914021
Number of Individuals Covered	364
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $81,500
Total amount of fees paid to insurance company	USD $3,562
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,492,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,500
Amount paid for insurance broker fees	3562
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	261
Insurance policy start date	2018-03-01
Insurance policy end date	2019-03-01
Total amount of commissions paid to insurance broker	USD $2,436
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,436
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	261
Insurance policy start date	2018-03-01
Insurance policy end date	2019-03-01
Total amount of commissions paid to insurance broker	USD $2,830
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,830
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	283
Insurance policy start date	2018-03-01
Insurance policy end date	2019-03-01
Total amount of commissions paid to insurance broker	USD $270
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $270
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	283
Insurance policy start date	2018-03-01
Insurance policy end date	2019-03-01
Total amount of commissions paid to insurance broker	USD $4,057
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,057
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

914021

Policy instance

Insurance contract or identification number	914021
Number of Individuals Covered	376
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $72,392
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,205,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,392
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	249
Insurance policy start date	2017-03-01
Insurance policy end date	2018-03-01
Total amount of commissions paid to insurance broker	USD $914
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $914
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	249
Insurance policy start date	2017-03-01
Insurance policy end date	2018-03-01
Total amount of commissions paid to insurance broker	USD $1,196
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,196
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	286
Insurance policy start date	2017-03-01
Insurance policy end date	2018-03-01
Total amount of commissions paid to insurance broker	USD $122
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $122
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	286
Insurance policy start date	2017-03-01
Insurance policy end date	2018-03-01
Total amount of commissions paid to insurance broker	USD $1,292
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,292
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CAREFIRST BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 47058 )

Policy contract number

67002/198W

Policy instance

Insurance contract or identification number	67002/198W
Number of Individuals Covered	244
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $81,952
Total amount of fees paid to insurance company	USD $28,661
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,530,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,952
Amount paid for insurance broker fees	28661
Additional information about fees paid to insurance broker	CONTRACT FEES AND NON-MONETARY INCENTIVES
Insurance broker organization code?	3

CAREFIRST BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 47058 )

Policy contract number

67002/198W

Policy instance

Insurance contract or identification number	67002/198W
Number of Individuals Covered	246
Insurance policy start date	2016-03-01
Insurance policy end date	2017-02-28
Total amount of commissions paid to insurance broker	USD $86,590
Total amount of fees paid to insurance company	USD $16,570
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,349,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,978
Insurance broker organization code?	3
Amount paid for insurance broker fees	101
Additional information about fees paid to insurance broker	NON-MONETARY INCENTIVES
Insurance broker name	MATHER & STROHL ADMINISTRATIVE SERV

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	283
Insurance policy start date	2016-11-01
Insurance policy end date	2017-03-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	283
Insurance policy start date	2016-11-01
Insurance policy end date	2017-03-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	244
Insurance policy start date	2016-11-01
Insurance policy end date	2017-03-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	244
Insurance policy start date	2016-11-01
Insurance policy end date	2017-03-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	252
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	252
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	289
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	289
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	231
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $66,584
Total amount of fees paid to insurance company	USD $17,497
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,130,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,584
Amount paid for insurance broker fees	17497
Insurance broker organization code?	3
Insurance broker name	HUMAN CAPITAL CONSULTANTS, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	394
Insurance policy start date	2013-11-01
Insurance policy end date	2014-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	265
Insurance policy start date	2013-11-01
Insurance policy end date	2014-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	226
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $56,941
Total amount of fees paid to insurance company	USD $18,463
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,579,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,941
Amount paid for insurance broker fees	18463
Insurance broker organization code?	3
Insurance broker name	HUMAN CAPITAL CONSULTANTS, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	229
Insurance policy start date	2013-11-01
Insurance policy end date	2014-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	229
Insurance policy start date	2013-11-01
Insurance policy end date	2014-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	236
Insurance policy start date	2012-11-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	236
Insurance policy start date	2012-11-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	358
Insurance policy start date	2012-11-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	223
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $62,311
Total amount of fees paid to insurance company	USD $7,785
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,976,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,311
Amount paid for insurance broker fees	7785
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	HUMAN CAPITAL CONSULTANTS, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	387
Insurance policy start date	2012-11-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $4,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	229
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-28
Total amount of commissions paid to insurance broker	USD $49,173
Total amount of fees paid to insurance company	USD $4,322
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,639,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,173
Amount paid for insurance broker fees	4322
Insurance broker organization code?	3
Insurance broker name	HUMAN CAPITAL CONSULTANTS, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	250
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	250
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	229
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	229
Insurance policy start date	2011-11-01
Insurance policy end date	2012-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	229
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-28
Total amount of commissions paid to insurance broker	USD $49,173
Total amount of fees paid to insurance company	USD $19,044
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,639,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	360
Insurance policy start date	2010-11-01
Insurance policy end date	2011-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	398
Insurance policy start date	2010-11-01
Insurance policy end date	2011-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	225
Insurance policy start date	2010-11-01
Insurance policy end date	2011-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	225
Insurance policy start date	2010-11-01
Insurance policy end date	2011-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

198W

Policy instance

Insurance contract or identification number	198W
Number of Individuals Covered	222
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $37,033
Total amount of fees paid to insurance company	USD $39,082
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,855,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,033
Amount paid for insurance broker fees	19743
Additional information about fees paid to insurance broker	MEDICAL CONTRACTS 231X85.08 19,653 NON-MONETARY
Insurance broker organization code?	3
Insurance broker name	BENEFITMALL

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

OK 960746

Policy instance

Insurance contract or identification number	OK 960746
Number of Individuals Covered	294
Insurance policy start date	2009-11-01
Insurance policy end date	2010-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 750162

Policy instance

Insurance contract or identification number	LK 750162
Number of Individuals Covered	221
Insurance policy start date	2009-11-01
Insurance policy end date	2010-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

LK 960727

Policy instance

Insurance contract or identification number	LK 960727
Number of Individuals Covered	221
Insurance policy start date	2009-11-01
Insurance policy end date	2010-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3322036

Policy instance

Insurance contract or identification number	3322036
Number of Individuals Covered	202
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLX960850

Policy instance

Insurance contract or identification number	FLX960850
Number of Individuals Covered	352
Insurance policy start date	2009-11-01
Insurance policy end date	2010-11-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HENDERSEN-WEBB INC
Employer identification number (EIN):	521008297
NAIC Classification:	531110
NAIC Description:	Lessors of Residential Buildings and Dwellings

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	JAMIE LUBLINER	2024-09-23
501	2022-01-01	JAMIE LUBLINER	2023-07-07
501	2021-01-01	PAMELA F. NEWLAND	2022-07-18
501	2020-01-01	PAMELA F. NEWLAND	2021-07-23
501	2019-01-01	PAMELA F. NEWLAND	2020-10-02
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	PAMELA F. NEWLAND
501	2011-01-01	PAMELA F. NEWLAND
501	2009-01-01	PAMELA F. NEWLAND