401k Plan data: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. plan

GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 401k Plan overview

Plan Name	GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC.
Plan identification number	501

GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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

COOKS PEST CONTROL CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: COOKS PEST CONTROL CO., INC.

Employer identification number (EIN): 630476716

NAIC Classification: 561710
NAIC Description: Exterminating and Pest Control Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JIM AYCOCK JIM AYCOCK
501 2021-01-01 JIM AYCOCK JIM AYCOCK
501 2020-01-01 ROBIN JACKSON 2021-10-11 ROBIN JACKSON 2021-10-11
501 2019-01-01
501 2018-01-01
501 2017-01-01 ROBIN JACKSON ROBIN JACKSON 2018-07-27
501 2016-01-01 ROBIN JACKSON ROBIN JACKSON 2017-09-20
501 2015-01-01 ROBIN JACKSON 2016-10-12 ROBIN JACKSON 2016-10-12
501 2014-01-01 CARL MONIN 2015-10-12 CARL MONIN 2015-10-12
501 2013-01-01 GEORGE T. WHITE 2014-09-02 GEORGE T. WHITE 2014-09-02
501 2012-01-01 GEORGE T. WHITE 2013-10-02 GEORGE T. WHITE 2013-10-02
501 2011-01-01 GEORGE T. WHITE GEORGE T. WHITE 2012-10-02
501 2009-01-01 GEORGE T. WHITE GEORGE T. WHITE 2010-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	JIM AYCOCK		JIM AYCOCK
501	2021-01-01	JIM AYCOCK		JIM AYCOCK
501	2020-01-01	ROBIN JACKSON	2021-10-11	ROBIN JACKSON	2021-10-11
501	2019-01-01
501	2018-01-01
501	2017-01-01	ROBIN JACKSON		ROBIN JACKSON	2018-07-27
501	2016-01-01	ROBIN JACKSON		ROBIN JACKSON	2017-09-20
501	2015-01-01	ROBIN JACKSON	2016-10-12	ROBIN JACKSON	2016-10-12
501	2014-01-01	CARL MONIN	2015-10-12	CARL MONIN	2015-10-12
501	2013-01-01	GEORGE T. WHITE	2014-09-02	GEORGE T. WHITE	2014-09-02
501	2012-01-01	GEORGE T. WHITE	2013-10-02	GEORGE T. WHITE	2013-10-02
501	2011-01-01	GEORGE T. WHITE		GEORGE T. WHITE	2012-10-02
501	2009-01-01	GEORGE T. WHITE		GEORGE T. WHITE	2010-10-07

Plan Statistics for GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC.

401k plan membership statisitcs for GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC.

Measure Date Value
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,655
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,541
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 1,541
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,655
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,655
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 1,655
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,658
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,655
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 1,655
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,625
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,658
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 1,658
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,532
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,603
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 1,603
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,532
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 1,532
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,316
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,433
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 1,433
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,031
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,316
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,316
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 976
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,031
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 1,031
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 984
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 976
Total of all active and inactive participants 2013-01-01 976
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 980
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 984
Total of all active and inactive participants 2012-01-01 984
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 974
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 980
Total of all active and inactive participants 2011-01-01 980
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 985
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 985
Total of all active and inactive participants 2009-01-01 985

Measure	Date	Value
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,655
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,541
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	1,541
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,655
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,655
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	1,655
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,658
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,655
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	1,655
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,625
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,658
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	1,658
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,532
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,603
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	1,603
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,532
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,532
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,316
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,433
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	1,433
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,031
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,316
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,316
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	976
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,031
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	1,031
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	984
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	976
Total of all active and inactive participants	2013-01-01	976
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	980
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	984
Total of all active and inactive participants	2012-01-01	984
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	974
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	980
Total of all active and inactive participants	2011-01-01	980
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	985
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	985
Total of all active and inactive participants	2009-01-01	985

Form 5500 Responses for GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC.

2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF COOK'S PEST CONTROL, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	76
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1185
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	533
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1541
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
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1465
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $273,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1541
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $290,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1655
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1577
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 $237,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1655
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
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	503
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1185
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	78
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1655
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $43,339
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,339
Insurance broker organization code?	3

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1577
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,542
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $235,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,542
Insurance broker organization code?	3

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1655
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $485
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $485
Insurance broker organization code?	3

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	503
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,891
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,891
Insurance broker organization code?	3

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1185
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,974
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,974
Insurance broker organization code?	3

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	78
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,598
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,598
Insurance broker organization code?	3

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1658
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $53,492
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $356,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,492
Insurance broker organization code?	3

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1546
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $29,901
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $299,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,901
Insurance broker organization code?	3

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1623
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $594
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $594
Insurance broker organization code?	3

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	313
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,639
Total amount of fees paid to insurance company	USD $233
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,639
Amount paid for insurance broker fees	233
Insurance broker organization code?	3

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1201
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,456
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,456
Insurance broker organization code?	3

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	77
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,159
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,159
Insurance broker organization code?	3

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1532
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $51,897
Are there contracts with allocated funds for individual policies?	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,897
Insurance broker organization code?	3

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1527
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $24,586
Are there contracts with allocated funds for individual policies?	1
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $245,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,586

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1603
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $523
Are there contracts with allocated funds for individual policies?	1
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $523

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	233
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $3,106
Total amount of fees paid to insurance company	USD $1,300
Are there contracts with allocated funds for individual policies?	1
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,106
Amount paid for insurance broker fees	1300

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	76
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $2,640
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,640

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1120
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $13,543
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
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 $13,543
Insurance broker organization code?	3

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

Policy contract number

30056485

Policy instance

Insurance contract or identification number	30056485
Number of Individuals Covered	1120
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $13,543
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,543
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER, INC.

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

Policy contract number

VPL302285

Policy instance

Insurance contract or identification number	VPL302285
Number of Individuals Covered	233
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,601
Are there contracts with allocated funds for individual policies?	1
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,601
Insurance broker name	J SMITH LANIER & CO

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1532
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $469
Are there contracts with allocated funds for individual policies?	1
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $469
Insurance broker name	J SMITH LANIER & CO

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1532
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $18,749
Are there contracts with allocated funds for individual policies?	1
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $187,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,749
Insurance broker name	J SMITH LANIER & CO

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1532
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $46,225
Are there contracts with allocated funds for individual policies?	1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $308,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,225
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1316
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $46,021
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,021
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1316
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $14,208
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,208
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1316
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $490
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $490
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	76
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $2,704
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,704
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403662

Policy instance

Insurance contract or identification number	403662
Number of Individuals Covered	1071
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $24,290
Welfare Benefit Premiums Paid to Carrier	USD $269,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,290
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1270
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $435
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $435
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	73
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $2,362
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,362
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403662

Policy instance

Insurance contract or identification number	403662
Number of Individuals Covered	1042
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $22,538
Welfare Benefit Premiums Paid to Carrier	USD $250,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,538
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1270
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $47,991
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,991
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1270
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $12,610
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,610
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1258
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $28,949
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $289,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,949
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1258
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $12,103
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,103
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	75
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $2,201
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,201
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403662

Policy instance

Insurance contract or identification number	403662
Number of Individuals Covered	994
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $22,313
Welfare Benefit Premiums Paid to Carrier	USD $247,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,313
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1258
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $419
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $419
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403662

Policy instance

Insurance contract or identification number	403662
Number of Individuals Covered	984
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $22,678
Welfare Benefit Premiums Paid to Carrier	USD $226,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,678
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	75
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $2,190
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,190
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1234
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $413
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $413
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1234
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $12,051
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,051
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1229
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $29,868
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $292,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,868
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

LTD118211

Policy instance

Insurance contract or identification number	LTD118211
Number of Individuals Covered	70
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $2,751
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,511
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

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1189
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $409
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,091
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

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1189
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $13,506
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

1003567000

Policy instance

Insurance contract or identification number	1003567000
Number of Individuals Covered	78
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $31,925
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $630,262
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

G000AD3S

Policy instance

Insurance contract or identification number	G000AD3S
Number of Individuals Covered	918
Insurance policy start date	2010-06-01
Insurance policy end date	2011-06-01
Total amount of commissions paid to insurance broker	USD $21,285
Welfare Benefit Premiums Paid to Carrier	USD $177,374
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

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1189
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $40,227
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $309,436
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

G159736

Policy instance

Insurance contract or identification number	G159736
Number of Individuals Covered	1209
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $13,425
Total amount of fees paid to insurance company	USD $4,269
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,425
Amount paid for insurance broker fees	4269
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

1003567000

Policy instance

Insurance contract or identification number	1003567000
Number of Individuals Covered	85
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $29,787
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $609,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,787
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFIT CORPORATION

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

Policy contract number

G000AD3S

Policy instance

Insurance contract or identification number	G000AD3S
Number of Individuals Covered	898
Insurance policy start date	2009-06-01
Insurance policy end date	2010-06-01
Total amount of commissions paid to insurance broker	USD $18,476
Welfare Benefit Premiums Paid to Carrier	USD $153,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,476
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Insurance broker name	J. SMITH LANIER & COMPANY

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

Policy contract number

GL144391

Policy instance

Insurance contract or identification number	GL144391
Number of Individuals Covered	1209
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $40,755
Total amount of fees paid to insurance company	USD $9,527
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $313,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,755
Amount paid for insurance broker fees	9527
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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

Policy contract number

VAR204333

Policy instance

Insurance contract or identification number	VAR204333
Number of Individuals Covered	1209
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $405
Total amount of fees paid to insurance company	USD $129
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $405
Amount paid for insurance broker fees	129
Insurance broker organization code?	3
Insurance broker name	THE WENZLER AGENCY

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Company Name:	COOKS PEST CONTROL CO., INC.
Employer identification number (EIN):	630476716
NAIC Classification:	561710
NAIC Description:	Exterminating and Pest Control Services