401k Plan data: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN plan

ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN
Plan identification number	502

ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

ROSEN HOTELS & RESORTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ROSEN HOTELS & RESORTS, INC.

Employer identification number (EIN): 591536217

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01 FRANK A SANTOS FRANK A SANTOS 2019-06-27
502 2017-01-01 FRANK A SANTOS FRANK A SANTOS 2018-06-28
502 2016-01-01 FRANK A SANTOS FRANK A SANTOS 2017-06-27
502 2015-01-01 FRANK A SANTOS FRANK A SANTOS 2016-05-31
502 2014-01-01 FRANK A SANTOS FRANK A SANTOS 2015-06-16
502 2013-01-01 FRANK A SANTOS FRANK A SANTOS 2014-07-06
502 2012-01-01 FRANK A SANTOS FRANK A SANTOS 2013-06-05
502 2011-01-01 FRANK A SANTOS FRANK A SANTOS 2012-07-11
502 2010-01-01 FRANK A SANTOS FRANK A SANTOS 2011-06-15
502 2009-01-01 FRANK SANTOS FRANK SANTOS 2010-06-24

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01
502	2022-01-01
502	2021-01-01
502	2020-01-01
502	2019-01-01
502	2018-01-01	FRANK A SANTOS	FRANK A SANTOS	2019-06-27
502	2017-01-01	FRANK A SANTOS	FRANK A SANTOS	2018-06-28
502	2016-01-01	FRANK A SANTOS	FRANK A SANTOS	2017-06-27
502	2015-01-01	FRANK A SANTOS	FRANK A SANTOS	2016-05-31
502	2014-01-01	FRANK A SANTOS	FRANK A SANTOS	2015-06-16
502	2013-01-01	FRANK A SANTOS	FRANK A SANTOS	2014-07-06
502	2012-01-01	FRANK A SANTOS	FRANK A SANTOS	2013-06-05
502	2011-01-01	FRANK A SANTOS	FRANK A SANTOS	2012-07-11
502	2010-01-01	FRANK A SANTOS	FRANK A SANTOS	2011-06-15
502	2009-01-01	FRANK SANTOS	FRANK SANTOS	2010-06-24

Plan Statistics for ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2023: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 1,993
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 2,229
Total of all active and inactive participants 2023-01-01 2,229
Total participants 2023-01-01 2,229
2022: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,797
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,993
Total of all active and inactive participants 2022-01-01 1,993
Total participants 2022-01-01 1,993
2021: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,021
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,797
Total of all active and inactive participants 2021-01-01 1,797
Total participants 2021-01-01 1,797
2020: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,857
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,963
Number of retired or separated participants receiving benefits 2020-01-01 58
Total of all active and inactive participants 2020-01-01 2,021
Total participants 2020-01-01 2,021
2019: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,795
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2,854
Number of retired or separated participants receiving benefits 2019-01-01 3
Total of all active and inactive participants 2019-01-01 2,857
Total participants 2019-01-01 2,857
2018: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,669
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2,789
Number of retired or separated participants receiving benefits 2018-01-01 6
Total of all active and inactive participants 2018-01-01 2,795
Total participants 2018-01-01 2,795
2017: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,737
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,662
Number of retired or separated participants receiving benefits 2017-01-01 7
Total of all active and inactive participants 2017-01-01 2,669
Total participants 2017-01-01 2,669
2016: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2,712
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,733
Number of retired or separated participants receiving benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 2,737
Total participants 2016-01-01 2,737
2015: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,568
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2,710
Number of retired or separated participants receiving benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 2,712
Total participants 2015-01-01 2,712
2014: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,425
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,563
Number of retired or separated participants receiving benefits 2014-01-01 5
Total of all active and inactive participants 2014-01-01 2,568
Total participants 2014-01-01 2,568
2013: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,246
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,421
Number of retired or separated participants receiving benefits 2013-01-01 4
Total of all active and inactive participants 2013-01-01 2,425
Total participants 2013-01-01 2,425
2012: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4,369
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,234
Number of retired or separated participants receiving benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 2,246
Total participants 2012-01-01 2,246
2011: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3,998
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4,369
Total of all active and inactive participants 2011-01-01 4,369
Total participants 2011-01-01 4,369
2010: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4,341
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3,998
Total of all active and inactive participants 2010-01-01 3,998
Total participants 2010-01-01 3,998
2009: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4,711
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4,341
Total of all active and inactive participants 2009-01-01 4,341
Total participants 2009-01-01 4,341

Measure	Date	Value
2023: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	1,993
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	2,229
Total of all active and inactive participants	2023-01-01	2,229
Total participants	2023-01-01	2,229
2022: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,797
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,993
Total of all active and inactive participants	2022-01-01	1,993
Total participants	2022-01-01	1,993
2021: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,021
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,797
Total of all active and inactive participants	2021-01-01	1,797
Total participants	2021-01-01	1,797
2020: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,857
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,963
Number of retired or separated participants receiving benefits	2020-01-01	58
Total of all active and inactive participants	2020-01-01	2,021
Total participants	2020-01-01	2,021
2019: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,795
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,854
Number of retired or separated participants receiving benefits	2019-01-01	3
Total of all active and inactive participants	2019-01-01	2,857
Total participants	2019-01-01	2,857
2018: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,669
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2,789
Number of retired or separated participants receiving benefits	2018-01-01	6
Total of all active and inactive participants	2018-01-01	2,795
Total participants	2018-01-01	2,795
2017: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,737
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,662
Number of retired or separated participants receiving benefits	2017-01-01	7
Total of all active and inactive participants	2017-01-01	2,669
Total participants	2017-01-01	2,669
2016: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,712
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,733
Number of retired or separated participants receiving benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	2,737
Total participants	2016-01-01	2,737
2015: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,568
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,710
Number of retired or separated participants receiving benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	2,712
Total participants	2015-01-01	2,712
2014: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,425
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,563
Number of retired or separated participants receiving benefits	2014-01-01	5
Total of all active and inactive participants	2014-01-01	2,568
Total participants	2014-01-01	2,568
2013: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,246
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,421
Number of retired or separated participants receiving benefits	2013-01-01	4
Total of all active and inactive participants	2013-01-01	2,425
Total participants	2013-01-01	2,425
2012: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4,369
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,234
Number of retired or separated participants receiving benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	2,246
Total participants	2012-01-01	2,246
2011: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3,998
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,369
Total of all active and inactive participants	2011-01-01	4,369
Total participants	2011-01-01	4,369
2010: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4,341
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3,998
Total of all active and inactive participants	2010-01-01	3,998
Total participants	2010-01-01	3,998
2009: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4,711
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4,341
Total of all active and inactive participants	2009-01-01	4,341
Total participants	2009-01-01	4,341

Form 5500 Responses for ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN

2023: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: ROSEN HOTELS AND RESORTS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan 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

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	1848
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $49,578
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $495,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	397
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $28,158
Total amount of fees paid to insurance company	USD $7,692
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	3034
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,537
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $88,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	552
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $67,482
Total amount of fees paid to insurance company	USD $7,692
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $269,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	626
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $59,815
Total amount of fees paid to insurance company	USD $7,692
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $239,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	3949
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	406
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,118
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $271,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

ESL150007300

Policy instance

Insurance contract or identification number	ESL150007300
Number of Individuals Covered	2229
Insurance policy start date	2023-02-01
Insurance policy end date	2024-02-01
Total amount of commissions paid to insurance broker	USD $40,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

915097

Policy instance

Insurance contract or identification number	915097
Number of Individuals Covered	1775
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $23,541
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $260,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	78
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $702,566
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	1354
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $69,044
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $377,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	553
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $52,883
Total amount of fees paid to insurance company	USD $4,280
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $211,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,730
Insurance broker organization code?	3
Amount paid for insurance broker fees	4280

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	472
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $54,405
Total amount of fees paid to insurance company	USD $4,234
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $217,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,643
Insurance broker organization code?	3
Amount paid for insurance broker fees	4234

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $54,405
Total amount of fees paid to insurance company	USD $4,234
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $217,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,762
Amount paid for insurance broker fees	4234
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	2649
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,050
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $77,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,050
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	336
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $21,971
Total amount of fees paid to insurance company	USD $1,748
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,183
Insurance broker organization code?	3
Amount paid for insurance broker fees	1748

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	1712
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $44,624
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $446,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,624
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	304
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $19,825
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,825
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	546
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $82,202
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $323,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,101
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	3552
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	82
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,459
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $546
Insurance broker organization code?	3

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

Policy contract number

915097

Policy instance

Insurance contract or identification number	915097
Number of Individuals Covered	1521
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $21,922
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $200,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,922
Insurance broker organization code?	3

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

Policy contract number

NWES0015102

Policy instance

Insurance contract or identification number	NWES0015102
Number of Individuals Covered	2210
Insurance policy start date	2022-02-01
Insurance policy end date	2023-02-01
Total amount of commissions paid to insurance broker	USD $33,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,387
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	219
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $21,853
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,741
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	2003
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,303
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $63,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,303
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068999

Policy instance

Insurance contract or identification number	000010068999
Number of Individuals Covered	44
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,365
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,365
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	317
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $52,928
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $211,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,757
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	706
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $53,502
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $214,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,101
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	1568
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $38,457
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,457
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	224
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $14,818
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,818
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	94
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,418
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $698

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	400
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,832
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,919
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	3006
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

915097

Policy instance

Insurance contract or identification number	915097
Number of Individuals Covered	1451
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $22,135
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,135
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	300
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $112,212
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $448,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,327
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068999

Policy instance

Insurance contract or identification number	000010068999
Number of Individuals Covered	48
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,451
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,451
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	2293
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,284
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $86,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,284
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	195
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $42,418
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $169,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,451
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	368
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $93,110
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $372,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,866
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	3859
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $57,407
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $574,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,407
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	370
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $17,852
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,852
Insurance broker organization code?	3

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

Policy contract number

915097

Policy instance

Insurance contract or identification number	915097
Number of Individuals Covered	1425
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27,277
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $268,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,277
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	94
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,907
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,156
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	539
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $52,836
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $437,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,450
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	2833
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068999

Policy instance

Insurance contract or identification number	000010068999
Number of Individuals Covered	48
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,037
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,037
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	1274
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $134,895
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $539,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,937
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	1263
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $119,618
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $478,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,771
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	2648
Insurance policy start date	2012-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $63,573
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $635,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,573
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	475
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,404
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $174,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,404
Insurance broker organization code?	3

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

Policy contract number

915097

Policy instance

Insurance contract or identification number	915097
Number of Individuals Covered	1982
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,019
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 $27,019
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	159
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,030
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	2412
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $98,864
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $694,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,432
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	4352
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $99,845
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	99845

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	3208
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,033
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $100,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,033
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	762
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $52,607
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $210,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,564
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	4347
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	719
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $42,013
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,208
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	3140
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,293
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $86,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,293
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068999

Policy instance

Insurance contract or identification number	000010068999
Number of Individuals Covered	45
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,451
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,451
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	1180
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $106,460
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $425,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,876
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	1249
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $92,168
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $368,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,301
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

78898

Policy instance

Insurance contract or identification number	78898
Number of Individuals Covered	5472
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $61,338
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $613,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,338
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

18950

Policy instance

Insurance contract or identification number	18950
Number of Individuals Covered	382
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,448
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,448
Insurance broker organization code?	3

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

Policy contract number

5473469

Policy instance

Insurance contract or identification number	5473469
Number of Individuals Covered	1871
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $25,613
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $256,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,613
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	171
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,212
Total amount of fees paid to insurance company	USD $23
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,679
Amount paid for insurance broker fees	22
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	1004
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $109,825
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $668,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,202
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	716
Total amount of commissions paid to insurance broker	USD $56,223
Total amount of fees paid to insurance company	USD $4,174
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $224,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,734
Amount paid for insurance broker fees	4174
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PREPARE BENEFITS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

00010068998

Policy instance

Insurance contract or identification number	00010068998
Number of Individuals Covered	2997
Total amount of commissions paid to insurance broker	USD $13,274
Total amount of fees paid to insurance company	USD $2,576
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $102,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,274
Amount paid for insurance broker fees	2576
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

0001D033053

Policy instance

Insurance contract or identification number	0001D033053
Number of Individuals Covered	2
Total amount of commissions paid to insurance broker	USD $43
Total amount of fees paid to insurance company	USD $23
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

0001D034207

Policy instance

Insurance contract or identification number	0001D034207
Number of Individuals Covered	2484
Total amount of commissions paid to insurance broker	USD $64,214
Total amount of fees paid to insurance company	USD $5,625
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $642,142
Commission paid to Insurance Broker	USD $64,214
Amount paid for insurance broker fees	5625
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

00001D033052

Policy instance

Insurance contract or identification number	00001D033052
Number of Individuals Covered	153
Total amount of commissions paid to insurance broker	USD $8,585
Total amount of fees paid to insurance company	USD $804
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,868
Amount paid for insurance broker fees	804
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PREPARE BENEFITS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068999

Policy instance

Insurance contract or identification number	000010068999
Number of Individuals Covered	45
Total amount of commissions paid to insurance broker	USD $7,624
Total amount of fees paid to insurance company	USD $1,486
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,624
Amount paid for insurance broker fees	1486
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000400135321

Policy instance

Insurance contract or identification number	000400135321
Number of Individuals Covered	1258
Total amount of commissions paid to insurance broker	USD $108,164
Total amount of fees paid to insurance company	USD $9,296
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $432,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,898
Amount paid for insurance broker fees	9296
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PREPARE BENEFITS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010135322

Policy instance

Insurance contract or identification number	000010135322
Number of Individuals Covered	1183
Total amount of commissions paid to insurance broker	USD $134,483
Total amount of fees paid to insurance company	USD $10,489
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $537,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,690
Amount paid for insurance broker fees	10489
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	PREPARE BENEFITS

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

Policy contract number

5473469

Policy instance

Insurance contract or identification number	5473469
Number of Individuals Covered	1795
Total amount of commissions paid to insurance broker	USD $23,253
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $233,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,253
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	189
Total amount of commissions paid to insurance broker	USD $5,193
Total amount of fees paid to insurance company	USD $46
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,143
Amount paid for insurance broker fees	35
Insurance broker organization code?	3
Insurance broker name	STEVEN VERMETTE INC

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G0681

Policy instance

Insurance contract or identification number	G0681
Number of Individuals Covered	1803
Total amount of commissions paid to insurance broker	USD $239,376
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $391,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $119,688
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	4388
Total amount of fees paid to insurance company	USD $84,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

75400

Policy instance

Insurance contract or identification number	75400
Number of Individuals Covered	5377
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $57,188
Dental 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 $57,188
Insurance broker organization code?	3
Insurance broker name	PROVINSURE INC

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

Policy contract number

D4X88

Policy instance

Insurance contract or identification number	D4X88
Number of Individuals Covered	839
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $126,145
Total amount of fees paid to insurance company	USD $20,522
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 $41,802
Amount paid for insurance broker fees	935
Insurance broker organization code?	3
Insurance broker name	TRISTAN GAINES

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	198
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,062
Health Insurance Welfare Benefit	Yes
Temporary 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 $14
Insurance broker organization code?	3
Insurance broker name	STEVEN VERMETTE INC.

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

Policy contract number

5473469

Policy instance

Insurance contract or identification number	5473469
Number of Individuals Covered	1506
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,514
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 $17,514
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	3021
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $239,042
Life 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 $87,356
Insurance broker organization code?	3
Insurance broker name	PROVINSURE

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	4467
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $99,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99,692
Insurance broker name

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

Policy contract number

3790

Policy instance

Insurance contract or identification number	3790
Number of Individuals Covered	2244
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $136,156
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 $1,173
Insurance broker organization code?	3
Insurance broker name	AMEALEO A THOMAS

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS4312

Policy instance

Insurance contract or identification number	VS4312
Number of Individuals Covered	2880
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,830
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 $16,830
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

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

Policy contract number

3790

Policy instance

Insurance contract or identification number	3790
Number of Individuals Covered	2126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $147,591
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 $456
Insurance broker organization code?	3
Insurance broker name	RICHARD ATTIEH

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

Policy contract number

D4X88

Policy instance

Insurance contract or identification number	D4X88
Number of Individuals Covered	782
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $143,481
Total amount of fees paid to insurance company	USD $2,649
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 $46,342
Amount paid for insurance broker fees	1289
Insurance broker organization code?	3
Insurance broker name	BARRY BEVERLY AND ASSOCIATES, INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

75400

Policy instance

Insurance contract or identification number	75400
Number of Individuals Covered	5167
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $53,158
Dental 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 $53,158
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

12908

Policy instance

Insurance contract or identification number	12908
Number of Individuals Covered	4291
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $97,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	97081
Insurance broker name

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	223
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,016
Total amount of fees paid to insurance company	USD $712
Health Insurance Welfare Benefit	Yes
Temporary 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 $2,316
Amount paid for insurance broker fees	533
Insurance broker organization code?	3
Insurance broker name	JOHN JOHNSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	2961
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $121,746
Life 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 $121,746
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

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

Policy contract number

3790

Policy instance

Insurance contract or identification number	3790
Number of Individuals Covered	1784
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $268,704
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 $102,662
Insurance broker organization code?	3
Insurance broker name	AMEALEO A THOMAS

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

Policy contract number

D4X88

Policy instance

Insurance contract or identification number	D4X88
Number of Individuals Covered	849
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $27,993
Total amount of fees paid to insurance company	USD $134
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 $9,513
Insurance broker organization code?	3
Amount paid for insurance broker fees	16
Insurance broker name	LESLIE K KIMBROUGH

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	242
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,731
Total amount of fees paid to insurance company	USD $596
Health Insurance Welfare Benefit	Yes
Temporary 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 $2,545
Amount paid for insurance broker fees	503
Insurance broker organization code?	3
Insurance broker name	GRS, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	2830
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $103,079
Life 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 $103,079
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS4312

Policy instance

Insurance contract or identification number	VS4312
Number of Individuals Covered	2865
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $13,995
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 $13,995
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	2653
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $97,136
Total amount of fees paid to insurance company	USD $11,551
Life 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 $97,136
Amount paid for insurance broker fees	11551
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

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

Policy contract number

3790

Policy instance

Insurance contract or identification number	3790
Number of Individuals Covered	1597
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $120,097
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 $661
Insurance broker organization code?	3
Insurance broker name	MARY ANN PHELPS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	279
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,974
Total amount of fees paid to insurance company	USD $1,153
Health Insurance Welfare Benefit	Yes
Temporary 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 $3,355
Insurance broker organization code?	3
Amount paid for insurance broker fees	1008
Insurance broker name	GRS INC

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS4312

Policy instance

Insurance contract or identification number	VS4312
Number of Individuals Covered	2594
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

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

Policy contract number

D4X88

Policy instance

Insurance contract or identification number	D4X88
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $56,483
Total amount of fees paid to insurance company	USD $412
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 $16,728
Insurance broker organization code?	3
Amount paid for insurance broker fees	53
Insurance broker name	LIZETTE SANTIAGO

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS4312

Policy instance

Insurance contract or identification number	VS4312
Number of Individuals Covered	1127
Insurance policy start date	2011-03-01
Insurance policy end date	2012-03-29
Total amount of commissions paid to insurance broker	USD $12,271
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Number of Individuals Covered	311
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,216
Total amount of fees paid to insurance company	USD $4,144
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

D4X88

Policy instance

Insurance contract or identification number	D4X88
Number of Individuals Covered	640
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $134,787
Total amount of fees paid to insurance company	USD $274
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

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

Policy contract number

3790

Policy instance

Insurance contract or identification number	3790
Number of Individuals Covered	3045
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $270,662
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010097448

Policy instance

Insurance contract or identification number	000010097448
Number of Individuals Covered	2115
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $82,821
Life 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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010068998

Policy instance

Insurance contract or identification number	000010068998
Number of Individuals Covered	2020
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $16,915
Total amount of fees paid to insurance company	USD $1,116
Life 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 $8,415
Insurance broker organization code?	3
Amount paid for insurance broker fees	228
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker name	PROVINSURE, INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7289358

Policy instance

Insurance contract or identification number	E7289358
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $96,217
Total amount of fees paid to insurance company	USD $9,126
Health Insurance Welfare Benefit	Yes
Temporary 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 $37,112
Insurance broker organization code?	3
Amount paid for insurance broker fees	3784
Additional information about fees paid to insurance broker	FEES
Insurance broker name	TINA GILLIAM

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

VS4312

Policy instance

Insurance contract or identification number	VS4312
Number of Individuals Covered	1060
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,629
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 $12,629
Insurance broker organization code?	3
Insurance broker name	PROVINSURE, INC.

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Company Name:	ROSEN HOTELS & RESORTS, INC.
Employer identification number (EIN):	591536217
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels