401k Plan data: BARNETT MILLWORKS, INC. INSURANCE PLAN plan

BARNETT MILLWORKS, INC. INSURANCE PLAN 401k Plan overview

Plan Name	BARNETT MILLWORKS, INC. INSURANCE PLAN
Plan identification number	501

BARNETT MILLWORKS, INC. INSURANCE 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

401k Sponsoring company profile

BARNETT MILLWORKS, INC. has sponsored the creation of one or more 401k plans.

Company Name: BARNETT MILLWORKS, INC.

Employer identification number (EIN): 630339935

NAIC Classification: 321210

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARNETT MILLWORKS, INC. INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 DANIEL E. BARBER DANIEL E. BARBER 2019-07-24
501 2017-01-01 DANIEL E. BARBER DANIEL E. BARBER 2018-07-10
501 2016-01-01 DANIEL E. BARBER DANIEL E. BARBER 2017-07-14
501 2015-01-01 DANIEL E. BARBER DANIEL E. BARBER 2016-04-25
501 2014-01-01 DANIEL E. BARBER DANIEL E. BARBER 2015-05-12
501 2013-01-01 DANIEL E. BARBER DANIEL E. BARBER 2014-05-01
501 2012-01-01 DANIEL E. BARBER DANIEL E. BARBER 2013-05-31
501 2011-01-01 DANIEL E. BARBER DANIEL E. BARBER 2012-06-30
501 2009-01-01 DANIEL E. BARBER DANIEL E. BARBER 2010-06-22
501 2009-01-01 DANIEL E. BARBER DANIEL E. BARBER 2010-06-30
501 2009-01-01 DANIEL E. BARBER DANIEL E. BARBER 2010-06-21

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2019-07-24
501	2017-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2018-07-10
501	2016-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2017-07-14
501	2015-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2016-04-25
501	2014-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2015-05-12
501	2013-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2014-05-01
501	2012-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2013-05-31
501	2011-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2012-06-30
501	2009-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2010-06-22
501	2009-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2010-06-30
501	2009-01-01	DANIEL E. BARBER	DANIEL E. BARBER	2010-06-21

Plan Statistics for BARNETT MILLWORKS, INC. INSURANCE PLAN

401k plan membership statisitcs for BARNETT MILLWORKS, INC. INSURANCE PLAN

Measure Date Value
2022: BARNETT MILLWORKS, INC. INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 190
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 170
Total of all active and inactive participants 2022-01-01 170
2021: BARNETT MILLWORKS, INC. INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 190
Total of all active and inactive participants 2021-01-01 190
2020: BARNETT MILLWORKS, INC. INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 198
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 197
Total of all active and inactive participants 2020-01-01 197
2019: BARNETT MILLWORKS, INC. INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 198
Total of all active and inactive participants 2019-01-01 198
2018: BARNETT MILLWORKS, INC. INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 176
Total of all active and inactive participants 2018-01-01 176
2017: BARNETT MILLWORKS, INC. INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 174
Total of all active and inactive participants 2017-01-01 174
2016: BARNETT MILLWORKS, INC. INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 158
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 167
Total of all active and inactive participants 2016-01-01 167
2015: BARNETT MILLWORKS, INC. INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 158
Total of all active and inactive participants 2015-01-01 158
2014: BARNETT MILLWORKS, INC. INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 163
Total of all active and inactive participants 2014-01-01 163
2013: BARNETT MILLWORKS, INC. INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 160
Total of all active and inactive participants 2013-01-01 160
2012: BARNETT MILLWORKS, INC. INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 154
Total of all active and inactive participants 2012-01-01 154
2011: BARNETT MILLWORKS, INC. INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 151
Total of all active and inactive participants 2011-01-01 151
2009: BARNETT MILLWORKS, INC. INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 174
Total of all active and inactive participants 2009-01-01 174

Measure	Date	Value
2022: BARNETT MILLWORKS, INC. INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	190
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	170
Total of all active and inactive participants	2022-01-01	170
2021: BARNETT MILLWORKS, INC. INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	190
Total of all active and inactive participants	2021-01-01	190
2020: BARNETT MILLWORKS, INC. INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	198
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	197
Total of all active and inactive participants	2020-01-01	197
2019: BARNETT MILLWORKS, INC. INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	198
Total of all active and inactive participants	2019-01-01	198
2018: BARNETT MILLWORKS, INC. INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	176
Total of all active and inactive participants	2018-01-01	176
2017: BARNETT MILLWORKS, INC. INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	174
Total of all active and inactive participants	2017-01-01	174
2016: BARNETT MILLWORKS, INC. INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	158
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	167
Total of all active and inactive participants	2016-01-01	167
2015: BARNETT MILLWORKS, INC. INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	158
Total of all active and inactive participants	2015-01-01	158
2014: BARNETT MILLWORKS, INC. INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	163
Total of all active and inactive participants	2014-01-01	163
2013: BARNETT MILLWORKS, INC. INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	160
Total of all active and inactive participants	2013-01-01	160
2012: BARNETT MILLWORKS, INC. INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	154
Total of all active and inactive participants	2012-01-01	154
2011: BARNETT MILLWORKS, INC. INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	151
Total of all active and inactive participants	2011-01-01	151
2009: BARNETT MILLWORKS, INC. INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	174
Total of all active and inactive participants	2009-01-01	174

Form 5500 Responses for BARNETT MILLWORKS, INC. INSURANCE PLAN

2022: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2021: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2020: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2019: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2018: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2017: BARNETT MILLWORKS, INC. INSURANCE 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 benefit arrangement – Insurance	Yes
2016: BARNETT MILLWORKS, INC. INSURANCE 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: BARNETT MILLWORKS, INC. INSURANCE 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: BARNETT MILLWORKS, INC. INSURANCE 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: BARNETT MILLWORKS, INC. INSURANCE 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: BARNETT MILLWORKS, INC. INSURANCE 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: BARNETT MILLWORKS, INC. INSURANCE 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
2009: BARNETT MILLWORKS, INC. INSURANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	68
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,610
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,661
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	227
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	169
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,081
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,183
Insurance broker organization code?	3

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	109
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,036
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,597
Insurance broker organization code?	3

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	171
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,224
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $726
Insurance broker organization code?	3

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	169
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,536
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,679
Insurance broker organization code?	3

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

Policy contract number

G000BYXV

Policy instance

Insurance contract or identification number	G000BYXV
Number of Individuals Covered	170
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,907
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,124
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	32
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,864
Total amount of fees paid to insurance company	USD $1,649
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1649
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,397

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

ACCID CRIT ILL

Policy instance

Insurance contract or identification number	ACCID CRIT ILL
Number of Individuals Covered	147
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,551
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,551
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	260
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	127
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,005
Total amount of fees paid to insurance company	USD $1,725
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1725
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,270

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	155
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,485
Total amount of fees paid to insurance company	USD $492
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,106
Amount paid for insurance broker fees	492
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	146
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,241
Total amount of fees paid to insurance company	USD $1,471
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,912
Amount paid for insurance broker fees	1471
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	101
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,135
Total amount of fees paid to insurance company	USD $826
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,708
Insurance broker organization code?	3
Amount paid for insurance broker fees	826
Additional information about fees paid to insurance broker	SERVICE FEE

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	183
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,275
Total amount of fees paid to insurance company	USD $1,562
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,275
Insurance broker organization code?	3
Amount paid for insurance broker fees	1562
Additional information about fees paid to insurance broker	SERVICE FEE

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	278
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

ACCID CRIT ILL

Policy instance

Insurance contract or identification number	ACCID CRIT ILL
Number of Individuals Covered	159
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,559
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,578
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	219
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,294
Total amount of fees paid to insurance company	USD $2,749
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,294
Insurance broker organization code?	3
Amount paid for insurance broker fees	2749
Additional information about fees paid to insurance broker	SERVICE FEE

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	183
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,368
Total amount of fees paid to insurance company	USD $521
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,368
Insurance broker organization code?	3
Amount paid for insurance broker fees	521
Additional information about fees paid to insurance broker	SERVICE FEE

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	183
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,454
Total amount of fees paid to insurance company	USD $1,617
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,454
Insurance broker organization code?	3
Amount paid for insurance broker fees	1617
Additional information about fees paid to insurance broker	SERVICE FEE

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	206
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,753
Total amount of fees paid to insurance company	USD $1,256
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,753
Insurance broker organization code?	3
Amount paid for insurance broker fees	1256
Additional information about fees paid to insurance broker	SERVICE FEE

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	274
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	178
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,572
Total amount of fees paid to insurance company	USD $948
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,610
Amount paid for insurance broker fees	948
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	114
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,418
Total amount of fees paid to insurance company	USD $938
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,665
Amount paid for insurance broker fees	938
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	178
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,139
Total amount of fees paid to insurance company	USD $302
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $519
Amount paid for insurance broker fees	302
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	178
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,728
Total amount of fees paid to insurance company	USD $989
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,677
Amount paid for insurance broker fees	989
Additional information about fees paid to insurance broker	SERVICE FEESERVICE FEE
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

005015

Policy instance

Insurance contract or identification number	005015
Number of Individuals Covered	172
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,356
Total amount of fees paid to insurance company	USD $548
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $664
Amount paid for insurance broker fees	548
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

ACCID CRIT ILL

Policy instance

Insurance contract or identification number	ACCID CRIT ILL
Number of Individuals Covered	147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $16,368
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,210
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155724

Policy instance

Insurance contract or identification number	000010155724
Number of Individuals Covered	176
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,458
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,458
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	176
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,847
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,847
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400155816

Policy instance

Insurance contract or identification number	000400155816
Number of Individuals Covered	129
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,017
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,017
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155723

Policy instance

Insurance contract or identification number	000010155723
Number of Individuals Covered	176
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,394
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,394
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	246
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIR MEDICAL SERVICES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	235
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $11,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155723

Policy instance

Insurance contract or identification number	000010155723
Number of Individuals Covered	176
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,383
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,383
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400155816

Policy instance

Insurance contract or identification number	000400155816
Number of Individuals Covered	112
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,761
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,761
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	176
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,837
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,246
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	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155724

Policy instance

Insurance contract or identification number	000010155724
Number of Individuals Covered	177
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,507
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,507
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155723

Policy instance

Insurance contract or identification number	000010155723
Number of Individuals Covered	160
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,264
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,264
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400155816

Policy instance

Insurance contract or identification number	000400155816
Number of Individuals Covered	101
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,402
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,402
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	160
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,679
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,679
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155724

Policy instance

Insurance contract or identification number	000010155724
Number of Individuals Covered	161
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,297
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,297
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	214
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $11,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	226
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $11,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155723

Policy instance

Insurance contract or identification number	000010155723
Number of Individuals Covered	156
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,969
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,969
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400155816

Policy instance

Insurance contract or identification number	000400155816
Number of Individuals Covered	91
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,269
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 $16,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,269
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	157
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,655
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 $11,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,655
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155724

Policy instance

Insurance contract or identification number	000010155724
Number of Individuals Covered	157
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,748
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,748
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	154
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,261
Total amount of fees paid to insurance company	USD $250
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 $8,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,261
Amount paid for insurance broker fees	250
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	221
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $10,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

35-0472300

Policy instance

Insurance contract or identification number	35-0472300
Number of Individuals Covered	153
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,917
Total amount of fees paid to insurance company	USD $968
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,917
Amount paid for insurance broker fees	968
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155724

Policy instance

Insurance contract or identification number	000010155724
Number of Individuals Covered	154
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,262
Total amount of fees paid to insurance company	USD $643
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 $21,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,262
Amount paid for insurance broker fees	643
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400155816

Policy instance

Insurance contract or identification number	000400155816
Number of Individuals Covered	88
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,135
Total amount of fees paid to insurance company	USD $474
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 $15,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,135
Amount paid for insurance broker fees	474
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138953

Policy instance

Insurance contract or identification number	GL 138953
Number of Individuals Covered	148
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $80
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 $740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

01228

Policy instance

Insurance contract or identification number	01228
Number of Individuals Covered	145
Insurance policy start date	2012-01-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $500
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $500
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010155722

Policy instance

Insurance contract or identification number	000010155722
Number of Individuals Covered	152
Insurance policy start date	2012-02-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,853
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 $68,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,853
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	207
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $10,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	215
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $10,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138953

Policy instance

Insurance contract or identification number	GL 138953
Number of Individuals Covered	147
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,013
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 $9,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

01228

Policy instance

Insurance contract or identification number	01228
Number of Individuals Covered	145
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,317
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

24485

Policy instance

Insurance contract or identification number	24485
Number of Individuals Covered	238
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EXPANDED PSYCHIATRIC SERVICES EPS
Welfare Benefit Premiums Paid to Carrier	USD $12,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

01228

Policy instance

Insurance contract or identification number	01228
Number of Individuals Covered	161
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,710
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,710
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138953

Policy instance

Insurance contract or identification number	GL 138953
Number of Individuals Covered	171
Insurance policy start date	2009-06-01
Insurance policy end date	2010-06-01
Total amount of commissions paid to insurance broker	USD $516
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 $11,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $516
Insurance broker organization code?	3
Insurance broker name	TIMOTHY T. JACKSON

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Company Name:	BARNETT MILLWORKS, INC.
Employer identification number (EIN):	630339935
NAIC Classification:	321210