401k Plan data: CHURCHILL DOWNS INCORPORATED WELFARE PLAN plan

CHURCHILL DOWNS INCORPORATED WELFARE PLAN 401k Plan overview

Plan Name	CHURCHILL DOWNS INCORPORATED WELFARE PLAN
Plan identification number	501

CHURCHILL DOWNS INCORPORATED WELFARE PLAN Benefits

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

401k Sponsoring company profile

CHURCHILL DOWNS INCORPORATED has sponsored the creation of one or more 401k plans.

Company Name: CHURCHILL DOWNS INCORPORATED

Employer identification number (EIN): 610156015

NAIC Classification: 713200
NAIC Description: Gambling Industries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHURCHILL DOWNS INCORPORATED WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 BRYSON TOMSKY 2024-07-03
501 2022-01-01 BRYSON TOMSKY 2023-06-07
501 2021-01-01 BRYSON TOMSKY 2022-07-05
501 2020-01-01 MACKENZIE HUNDLEY 2021-07-14
501 2019-01-01 MACKENZIE HUNDLEY 2020-07-06
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 DAWN COOPER
501 2011-01-01 DAWN COOPER
501 2010-01-01 DAWN COOPER
501 2009-01-01 DAWN COOPER
501 2009-01-01 DAWN COOPER
501 2009-01-01 DAWN COOPER DAWN COOPER 2010-06-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	BRYSON TOMSKY	2024-07-03
501	2022-01-01	BRYSON TOMSKY	2023-06-07
501	2021-01-01	BRYSON TOMSKY	2022-07-05
501	2020-01-01	MACKENZIE HUNDLEY	2021-07-14
501	2019-01-01	MACKENZIE HUNDLEY	2020-07-06
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	DAWN COOPER
501	2011-01-01	DAWN COOPER
501	2010-01-01	DAWN COOPER
501	2009-01-01	DAWN COOPER
501	2009-01-01	DAWN COOPER
501	2009-01-01	DAWN COOPER		DAWN COOPER	2010-06-16

Plan Statistics for CHURCHILL DOWNS INCORPORATED WELFARE PLAN

401k plan membership statisitcs for CHURCHILL DOWNS INCORPORATED WELFARE PLAN

Measure Date Value
2023: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 3,736
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 4,877
Total of all active and inactive participants 2023-01-01 4,877
2022: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,253
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3,736
Total of all active and inactive participants 2022-01-01 3,736
2021: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 3,144
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 3,253
Total of all active and inactive participants 2021-01-01 3,253
2020: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 3,798
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3,144
Total of all active and inactive participants 2020-01-01 3,144
2019: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,573
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 3,798
Total of all active and inactive participants 2019-01-01 3,798
2018: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3,020
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2,573
Total of all active and inactive participants 2018-01-01 2,573
2017: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,904
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3,020
Total of all active and inactive participants 2017-01-01 3,020
2016: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2,855
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,904
Total of all active and inactive participants 2016-01-01 2,904
2015: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3,009
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2,855
Total of all active and inactive participants 2015-01-01 2,855
2014: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,506
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3,009
Total of all active and inactive participants 2014-01-01 3,009
2013: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,322
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,506
Total of all active and inactive participants 2013-01-01 2,506
2012: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,838
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,322
Total of all active and inactive participants 2012-01-01 2,322
2011: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,505
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,838
Total of all active and inactive participants 2011-01-01 1,838
2010: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,383
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,505
Total of all active and inactive participants 2010-01-01 1,505
2009: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,255
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,383
Total of all active and inactive participants 2009-01-01 1,383

Measure	Date	Value
2023: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	3,736
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	4,877
Total of all active and inactive participants	2023-01-01	4,877
2022: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,253
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,736
Total of all active and inactive participants	2022-01-01	3,736
2021: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	3,144
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3,253
Total of all active and inactive participants	2021-01-01	3,253
2020: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	3,798
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3,144
Total of all active and inactive participants	2020-01-01	3,144
2019: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,573
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3,798
Total of all active and inactive participants	2019-01-01	3,798
2018: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,020
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2,573
Total of all active and inactive participants	2018-01-01	2,573
2017: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,904
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,020
Total of all active and inactive participants	2017-01-01	3,020
2016: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,855
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,904
Total of all active and inactive participants	2016-01-01	2,904
2015: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3,009
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,855
Total of all active and inactive participants	2015-01-01	2,855
2014: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,506
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3,009
Total of all active and inactive participants	2014-01-01	3,009
2013: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,322
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,506
Total of all active and inactive participants	2013-01-01	2,506
2012: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,838
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,322
Total of all active and inactive participants	2012-01-01	2,322
2011: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,505
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,838
Total of all active and inactive participants	2011-01-01	1,838
2010: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,383
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,505
Total of all active and inactive participants	2010-01-01	1,505
2009: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,255
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,383
Total of all active and inactive participants	2009-01-01	1,383

Form 5500 Responses for CHURCHILL DOWNS INCORPORATED WELFARE PLAN

2023: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE 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: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: CHURCHILL DOWNS INCORPORATED WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614594

Policy instance

Insurance contract or identification number	8614594
Number of Individuals Covered	93
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $19,809
Total amount of fees paid to insurance company	USD $9,888
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $118,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	4968
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $100,020
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	2924
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $32,717
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $384,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH ADVOCATE, INC. (National Association of Insurance Commissioners NAIC id number: 54160 )

Policy contract number

1092859

Policy instance

Insurance contract or identification number	1092859
Number of Individuals Covered	6777
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $249,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	2
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $64
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	381
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $38,245
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	6072
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $82,710
Total amount of fees paid to insurance company	USD $227,193
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,250,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	4877
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $24,288
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $161,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	2113
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $205,052
Total amount of fees paid to insurance company	USD $40,320
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $717,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	24
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,004
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W33006

Policy instance

Insurance contract or identification number	W33006
Number of Individuals Covered	4606
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $785,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	308
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $77,951
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,416
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	2
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $64
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,058
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
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614594

Policy instance

Insurance contract or identification number	8614594
Number of Individuals Covered	102
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $14,717
Total amount of fees paid to insurance company	USD $4,469
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,664
Amount paid for insurance broker fees	202
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	2418
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $30,447
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $321,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,447
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	4740
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $58,945
Total amount of fees paid to insurance company	USD $164,543
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,388,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	138190
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $58,945

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1888
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $345,826
Total amount of fees paid to insurance company	USD $32,658
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $605,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $171,317
Amount paid for insurance broker fees	24220
Additional information about fees paid to insurance broker	TECHNOLOGY FEE
Insurance broker organization code?	3

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	20
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $618
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $618
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W33006

Policy instance

Insurance contract or identification number	W33006
Number of Individuals Covered	4054
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $486,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH ADVOCATE, INC. (National Association of Insurance Commissioners NAIC id number: 54160 )

Policy contract number

1092859

Policy instance

Insurance contract or identification number	1092859
Number of Individuals Covered	4356
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	4181
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $98,150
Total amount of fees paid to insurance company	USD $0
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 $98,150
Insurance broker organization code?	7

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	3737
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,581
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $123,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,581
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1269
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $128,725
Total amount of fees paid to insurance company	USD $21,326
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $533,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,928
Insurance broker organization code?	3
Amount paid for insurance broker fees	5118
Additional information about fees paid to insurance broker	TECHNOLOGY FEE

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	3885
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $97,954
Total amount of fees paid to insurance company	USD $0
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 $97,954
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W33006

Policy instance

Insurance contract or identification number	W33006
Number of Individuals Covered	3881
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $457,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	4287
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $52,812
Total amount of fees paid to insurance company	USD $156,511
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,475,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	99178
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $52,812

BANNER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94250 )

Policy contract number

GB0005

Policy instance

Insurance contract or identification number	GB0005
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $742
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
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	2285
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $22,896
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $306,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,896
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614560

Policy instance

Insurance contract or identification number	8614560
Number of Individuals Covered	74
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $14,657
Total amount of fees paid to insurance company	USD $11,424
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,272
Amount paid for insurance broker fees	2222
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	3961
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,479
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,479
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	2
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $88
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,248
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
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	135
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,003
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,050
Insurance broker organization code?	3

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	3253
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,385
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $122,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,385
Insurance broker organization code?	3

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	19
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $95
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	4021
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,251
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,251
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614560

Policy instance

Insurance contract or identification number	8614560
Number of Individuals Covered	75
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $19,517
Total amount of fees paid to insurance company	USD $14,320
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,860
Amount paid for insurance broker fees	6167
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	2255
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $26,940
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $316,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,940
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	4070
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $81,890
Total amount of fees paid to insurance company	USD $0
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 $81,890
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	147
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,121
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,823
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	4173
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $212,593
Total amount of fees paid to insurance company	USD $25,157
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,499,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $111,652
Insurance broker organization code?	3
Amount paid for insurance broker fees	25157
Additional information about fees paid to insurance broker	BONUS

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	3144
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,639
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $124,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,639
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1427
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66,349
Total amount of fees paid to insurance company	USD $19,995
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $499,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,767
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SERVICE FEE

BANNER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94250 )

Policy contract number

GB0005

Policy instance

Insurance contract or identification number	GB0005
Number of Individuals Covered	62
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,348
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,782
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	20
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $483
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $483
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

004009997

Policy instance

Insurance contract or identification number	004009997
Number of Individuals Covered	4042
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $486,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	3930
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,095
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,095
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	38
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $4,553
Total amount of fees paid to insurance company	USD $1,034
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,556
Amount paid for insurance broker fees	509
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	2448
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $28,850
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,850
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	4455
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $92,443
Total amount of fees paid to insurance company	USD $0
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 $92,443
Insurance broker organization code?	3

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

ESL 1000408 02

Policy instance

Insurance contract or identification number	ESL 1000408 02
Number of Individuals Covered	2882
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $489,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $95
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	163
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,990
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,426
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	4686
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $55,560
Total amount of fees paid to insurance company	USD $151,742
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,409,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	138455
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	3798
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $16,794
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $111,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,794
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1394
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $75,870
Total amount of fees paid to insurance company	USD $18,251
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $456,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,057
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMIN FEE

BANNER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94250 )

Policy contract number

GB0005

Policy instance

Insurance contract or identification number	GB0005
Number of Individuals Covered	54
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,728
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,585
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	20
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $285
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $285
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	3213
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $43,207
Total amount of fees paid to insurance company	USD $121,367
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,116,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	111694
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351/352

Policy instance

Insurance contract or identification number	GTU 5466351/352
Number of Individuals Covered	3213
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,906
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $81,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,906
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1941
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $48,570
Total amount of fees paid to insurance company	USD $14,101
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $323,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,380
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATION FEE

BANNER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94250 )

Policy contract number

GB0005

Policy instance

Insurance contract or identification number	GB0005
Number of Individuals Covered	41
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,257
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,600
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

D516889

Policy instance

Insurance contract or identification number	D516889
Number of Individuals Covered	18
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $290
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $290
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	174
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,872
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,717
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $100
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $76
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2472
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,126
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,126
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	39
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of commissions paid to insurance broker	USD $4,974
Total amount of fees paid to insurance company	USD $1,075
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,850
Amount paid for insurance broker fees	426
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1706
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $20,861
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $208,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,861
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	3238
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $78,041
Total amount of fees paid to insurance company	USD $0
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 $78,041
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

ESL 1000408 00

Policy instance

Insurance contract or identification number	ESL 1000408 00
Number of Individuals Covered	2055
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $366,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	50
Insurance policy start date	2016-02-01
Insurance policy end date	2017-01-31
Total amount of commissions paid to insurance broker	USD $7,951
Total amount of fees paid to insurance company	USD $1,536
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,253
Amount paid for insurance broker fees	574
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INSURANCE AGENCY

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1573
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,857
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,857
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	3020
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $74,631
Total amount of fees paid to insurance company	USD $0
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 $74,631
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

ESL 1000408 00

Policy instance

Insurance contract or identification number	ESL 1000408 00
Number of Individuals Covered	1934
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $368,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2402
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,060
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,060
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	4
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $159
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	201
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,179
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,598
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	2864
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $33,114
Total amount of fees paid to insurance company	USD $91,129
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $853,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	85325
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	BB&T BARGER INSURANCE NETWORK

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351

Policy instance

Insurance contract or identification number	GTU 5466351
Number of Individuals Covered	2300
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $7,811
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $52,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,811
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

69042-2

Policy instance

Insurance contract or identification number	69042-2
Number of Individuals Covered	1582
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $46,806
Total amount of fees paid to insurance company	USD $10,972
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $274,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,431
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMIN FEE
Insurance broker name	BB&T INSURANCE SERVICES, INC.

BANNER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94250 )

Policy contract number

GB0005

Policy instance

Insurance contract or identification number	GB0005
Number of Individuals Covered	44
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,780
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,216
Insurance broker organization code?	3
Insurance broker name	TENNESSEE BROKERAGE AGENCY

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1313
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,034
Total amount of fees paid to insurance company	USD $0
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 $17,034
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0103425

Policy instance

Insurance contract or identification number	0103425
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,207
Total amount of fees paid to insurance company	USD $1,176
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,207
Amount paid for insurance broker fees	1176
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	65
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $8,625
Total amount of fees paid to insurance company	USD $2,133
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,187
Amount paid for insurance broker fees	1042
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INSURANCE AGENCY

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 5466351

Policy instance

Insurance contract or identification number	GTU 5466351
Number of Individuals Covered	2213
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $7,011
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $46,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,011
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1045910

Policy instance

Insurance contract or identification number	1045910
Number of Individuals Covered	2772
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $34,852
Total amount of fees paid to insurance company	USD $87,371
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $873,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	87371
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $34,852
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2310
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,044
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,044
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	425
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $38,518
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $163,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,175
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	2714
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $69,197
Total amount of fees paid to insurance company	USD $0
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 $69,197
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0730420

Policy instance

Insurance contract or identification number	0730420
Number of Individuals Covered	2855
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $874,648
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

15518

Policy instance

Insurance contract or identification number	15518
Number of Individuals Covered	785
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,978
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $234,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,913
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	316
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $36,031
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $159,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,049
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

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

Policy contract number

0730420

Policy instance

Insurance contract or identification number	0730420
Number of Individuals Covered	3009
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $291,105
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,555,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $291,105
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1376
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,767
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $16,767
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0103425

Policy instance

Insurance contract or identification number	0103425
Number of Individuals Covered	2607
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $34,970
Total amount of fees paid to insurance company	USD $6,662
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $928,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,970
Amount paid for insurance broker fees	6662
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	55
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $8,219
Total amount of fees paid to insurance company	USD $683
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,349
Amount paid for insurance broker fees	301
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INSURANCE AGENCY

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2689
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,249
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,249
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

15518

Policy instance

Insurance contract or identification number	15518
Number of Individuals Covered	1120
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $115,691
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $295,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,496
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	576
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $87,897
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	COMBO CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $195,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,614
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	456
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $97,137
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,405
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	2814
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $65,193
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,193
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0730420

Policy instance

Insurance contract or identification number	0730420
Number of Individuals Covered	2506
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $360,320
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,511,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $315,320
Insurance broker organization code?	3
Insurance broker name	BB&T

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1023
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,922
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $12,922
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0103425

Policy instance

Insurance contract or identification number	0103425
Number of Individuals Covered	2301
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $28,349
Total amount of fees paid to insurance company	USD $4,997
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $742,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,349
Amount paid for insurance broker fees	4997
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	61
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $11,739
Total amount of fees paid to insurance company	USD $3,612
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,214
Amount paid for insurance broker fees	1734
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INSURANCE AGENCY

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

Policy contract number

15518

Policy instance

Insurance contract or identification number	15518
Number of Individuals Covered	1189
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $131,839
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,209
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2296
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,053
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,053
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	608
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $68,625
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	COMBO CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $125,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,687
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0308800000

Policy instance

Insurance contract or identification number	0308800000
Number of Individuals Covered	464
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $64,043
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $138,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,395
Insurance broker organization code?	3
Insurance broker name	CRAIG ROWE

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	2208
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $57,287
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,044
Insurance broker organization code?	3
Insurance broker name	BENEFIT CO INC

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	1231
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $52,533
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,533
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	1067
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,301
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 $13,301
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0103425

Policy instance

Insurance contract or identification number	0103425
Number of Individuals Covered	2090
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $29,514
Total amount of fees paid to insurance company	USD $4,566
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $730,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,514
Amount paid for insurance broker fees	4566
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	56
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $12,715
Total amount of fees paid to insurance company	USD $531
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,288
Amount paid for insurance broker fees	240
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INS AGCY INC

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

CHCD0-001

Policy instance

Insurance contract or identification number	CHCD0-001
Number of Individuals Covered	2296
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,059
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,059
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0730420

Policy instance

Insurance contract or identification number	0730420
Number of Individuals Covered	2322
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $301,832
Total amount of fees paid to insurance company	USD $15,000
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,058,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $301,832
Insurance broker organization code?	3
Amount paid for insurance broker fees	15000
Additional information about fees paid to insurance broker	BONUS AMOUNT
Insurance broker name	BB&T

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	1808
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $48,955
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0123680

Policy instance

Insurance contract or identification number	0123680
Number of Individuals Covered	1143
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,820
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $110,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	897
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,888
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

103425

Policy instance

Insurance contract or identification number	103425
Number of Individuals Covered	1838
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $28,163
Total amount of fees paid to insurance company	USD $13,405
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $688,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0730420

Policy instance

Insurance contract or identification number	0730420
Number of Individuals Covered	2090
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $302,851
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,597,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GENWORTH LIFE AND ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65536 )

Policy contract number

W0000031

Policy instance

Insurance contract or identification number	W0000031
Number of Individuals Covered	53
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,631
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	55
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $12,293
Total amount of fees paid to insurance company	USD $2,477
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

103425

Policy instance

Insurance contract or identification number	103425
Number of Individuals Covered	1504
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $26,457
Total amount of fees paid to insurance company	USD $11,823
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $582,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,457
Amount paid for insurance broker fees	11823
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

HUMANA INSURANCE COMPANY OF KENTUCKY INC (National Association of Insurance Commissioners NAIC id number: 60219 )

Policy contract number

671311

Policy instance

Insurance contract or identification number	671311
Number of Individuals Covered	1001
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $213,855
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $213,855
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

000686130

Policy instance

Insurance contract or identification number	000686130
Number of Individuals Covered	1505
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $35,481
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,481
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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

Policy contract number

0103425

Policy instance

Insurance contract or identification number	0103425
Number of Individuals Covered	1144
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,695
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $110,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,695
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8614547

Policy instance

Insurance contract or identification number	8614547
Number of Individuals Covered	62
Insurance policy end date	2010-01-31
Total amount of commissions paid to insurance broker	USD $18,320
Total amount of fees paid to insurance company	USD $15,659
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,659
Amount paid for insurance broker fees	5217
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CAPITAL INS AGCY INC

GENWORTH LIFE AND ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65536 )

Policy contract number

W0000031

Policy instance

Insurance contract or identification number	W0000031
Number of Individuals Covered	47
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,709
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,837
Insurance broker organization code?	3
Insurance broker name	MAIN FINANCIAL SERVICES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12323478

Policy instance

Insurance contract or identification number	12323478
Number of Individuals Covered	489
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,595
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,595
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

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Company Name:	CHURCHILL DOWNS INCORPORATED
Employer identification number (EIN):	610156015
NAIC Classification:	713200
NAIC Description:	Gambling Industries