401k Plan data: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN plan

CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN
Plan identification number	501

CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

CITIZENS NATIONAL BANK OF MERIDIAN has sponsored the creation of one or more 401k plans.

Company Name: CITIZENS NATIONAL BANK OF MERIDIAN

Employer identification number (EIN): 640134521

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 TERRI MCKELVAINE 2023-07-05
501 2021-01-01 TERRI MCKELVAINE 2022-07-07
501 2020-01-01 TERRI MCKELVAINE 2021-07-19
501 2019-01-01 RICHARD JOHNSON 2020-06-09
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01 DONNA W BRUCE
501 2014-01-01 RICHARD JOHNSON
501 2013-01-01 RICHARD JOHNSON
501 2012-01-01 LINDA R MAY
501 2011-01-01 LINDA R MAY
501 2010-01-01 LINDA R MAY
501 2009-01-01 LINDA R MAY
501 2009-01-01 LINDA R MAY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	TERRI MCKELVAINE	2023-07-05
501	2021-01-01	TERRI MCKELVAINE	2022-07-07
501	2020-01-01	TERRI MCKELVAINE	2021-07-19
501	2019-01-01	RICHARD JOHNSON	2020-06-09
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01	DONNA W BRUCE
501	2014-01-01	RICHARD JOHNSON
501	2013-01-01	RICHARD JOHNSON
501	2012-01-01	LINDA R MAY
501	2011-01-01	LINDA R MAY
501	2010-01-01	LINDA R MAY
501	2009-01-01	LINDA R MAY
501	2009-01-01	LINDA R MAY

Plan Statistics for CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN

401k plan membership statisitcs for CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN

Measure Date Value
2022: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 445
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 521
Total of all active and inactive participants 2022-01-01 521
Total participants 2022-01-01 521
2021: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 454
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 445
Total of all active and inactive participants 2021-01-01 445
Total participants 2021-01-01 445
2020: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 467
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 454
Total of all active and inactive participants 2020-01-01 454
Total participants 2020-01-01 454
2019: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 461
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 467
Total of all active and inactive participants 2019-01-01 467
Total participants 2019-01-01 467
2018: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 728
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 461
Total of all active and inactive participants 2018-01-01 461
Total participants 2018-01-01 461
2017: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 576
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 728
Total of all active and inactive participants 2017-01-01 728
Total participants 2017-01-01 728
2016: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 785
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 576
Total of all active and inactive participants 2016-01-01 576
Total participants 2016-01-01 576
2015: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 417
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 785
Total of all active and inactive participants 2015-01-01 785
Total participants 2015-01-01 785
2014: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 417
Total of all active and inactive participants 2014-01-01 417
Total participants 2014-01-01 417
2013: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 374
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 263
Total of all active and inactive participants 2013-01-01 263
Total participants 2013-01-01 263
2012: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 374
Total of all active and inactive participants 2012-01-01 374
Total participants 2012-01-01 374
2011: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 370
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 361
Total of all active and inactive participants 2011-01-01 361
Total participants 2011-01-01 361
2010: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 370
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 370
Total of all active and inactive participants 2010-01-01 370
Total participants 2010-01-01 370
2009: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 383
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 370
Total of all active and inactive participants 2009-01-01 370
Total participants 2009-01-01 370

Measure	Date	Value
2022: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	445
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	521
Total of all active and inactive participants	2022-01-01	521
Total participants	2022-01-01	521
2021: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	454
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	445
Total of all active and inactive participants	2021-01-01	445
Total participants	2021-01-01	445
2020: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	467
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	454
Total of all active and inactive participants	2020-01-01	454
Total participants	2020-01-01	454
2019: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	461
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	467
Total of all active and inactive participants	2019-01-01	467
Total participants	2019-01-01	467
2018: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	728
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	461
Total of all active and inactive participants	2018-01-01	461
Total participants	2018-01-01	461
2017: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	576
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	728
Total of all active and inactive participants	2017-01-01	728
Total participants	2017-01-01	728
2016: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	785
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	576
Total of all active and inactive participants	2016-01-01	576
Total participants	2016-01-01	576
2015: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	417
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	785
Total of all active and inactive participants	2015-01-01	785
Total participants	2015-01-01	785
2014: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	417
Total of all active and inactive participants	2014-01-01	417
Total participants	2014-01-01	417
2013: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	374
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	263
Total of all active and inactive participants	2013-01-01	263
Total participants	2013-01-01	263
2012: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	374
Total of all active and inactive participants	2012-01-01	374
Total participants	2012-01-01	374
2011: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	361
Total of all active and inactive participants	2011-01-01	361
Total participants	2011-01-01	361
2010: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	370
Total of all active and inactive participants	2010-01-01	370
Total participants	2010-01-01	370
2009: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	370
Total of all active and inactive participants	2009-01-01	370
Total participants	2009-01-01	370

Form 5500 Responses for CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN

2022: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: CITIZENS NATIONAL BANK OF MERIDIAN WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615921

Policy instance

Insurance contract or identification number	G 00615921
Number of Individuals Covered	115
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,613
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,805
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,747
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $11,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,747
Insurance broker organization code?	3

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

Policy contract number

TM05974986

Policy instance

Insurance contract or identification number	TM05974986
Number of Individuals Covered	521
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $45,180
Total amount of fees paid to insurance company	USD $8,807
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $317,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,180
Amount paid for insurance broker fees	8807
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	112
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,352
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $62,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,226
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	467
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $63,280
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,280
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	445
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $62,180
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,180
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	108
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,120
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $59,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,955
Insurance broker organization code?	3

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

Policy contract number

TM05974986

Policy instance

Insurance contract or identification number	TM05974986
Number of Individuals Covered	530
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $40,292
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $335,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,292
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,597
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $10,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,597
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615921

Policy instance

Insurance contract or identification number	G 00615921
Number of Individuals Covered	107
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,173
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,173
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $1,250
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $8,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,250
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

CITNB117

Policy instance

Insurance contract or identification number	CITNB117
Number of Individuals Covered	209
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,435
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,435
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615921

Policy instance

Insurance contract or identification number	G 00615921
Number of Individuals Covered	98
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,888
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,888
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	454
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $64,180
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,180
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	99
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,285
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $55,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,272
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

692626

Policy instance

Insurance contract or identification number	692626
Number of Individuals Covered	207
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $16,672
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,672
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658333

Policy instance

Insurance contract or identification number	658333
Number of Individuals Covered	143
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $9,276
Other welfare benefits provided	LIFESTYLE AD&D, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $46,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,276
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658332

Policy instance

Insurance contract or identification number	658332
Number of Individuals Covered	300
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $17,250
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $115,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,250
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658333

Policy instance

Insurance contract or identification number	658333
Number of Individuals Covered	149
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $9,454
Other welfare benefits provided	LIFESTYLE AD&D, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $47,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,454
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	467
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $64,196
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,196
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

692626

Policy instance

Insurance contract or identification number	692626
Number of Individuals Covered	207
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $15,757
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,757
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	115
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,935
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $58,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,759
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615921

Policy instance

Insurance contract or identification number	G 00615921
Number of Individuals Covered	105
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,319
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,319
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

CITNB117

Policy instance

Insurance contract or identification number	CITNB117
Number of Individuals Covered	212
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,316
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,316
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $1,342
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $8,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,342
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658332

Policy instance

Insurance contract or identification number	658332
Number of Individuals Covered	308
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $17,383
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $115,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,383
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658333

Policy instance

Insurance contract or identification number	658333
Number of Individuals Covered	153
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $9,129
Other welfare benefits provided	LIFESTYLE AD&D, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $45,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,129
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

658332

Policy instance

Insurance contract or identification number	658332
Number of Individuals Covered	309
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $16,603
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $110,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,603
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

692626

Policy instance

Insurance contract or identification number	692626
Number of Individuals Covered	198
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $15,083
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,083
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	122
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,577
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $63,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,577
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	461
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $62,880
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,880
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615921

Policy instance

Insurance contract or identification number	G 00615921
Number of Individuals Covered	111
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,050
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,050
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

CITNB117

Policy instance

Insurance contract or identification number	CITNB117
Number of Individuals Covered	199
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,029
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,029
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $1,225
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $8,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,225
Insurance broker organization code?	3

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

Policy contract number

000010211404

Policy instance

Insurance contract or identification number	000010211404
Number of Individuals Covered	102
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,136
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,136
Insurance broker organization code?	3
Insurance broker name	ONE LIFE INSURANCE SERVICES INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521842

Policy instance

Insurance contract or identification number	00521842
Number of Individuals Covered	133
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,372
Other welfare benefits provided	CANCER, VOL. ACCIDENT/CRITICAL ILL.
Welfare Benefit Premiums Paid to Carrier	USD $68,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,243
Insurance broker organization code?	3
Insurance broker name	ALLEN FINANCIAL GROUP, PA

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $1,064
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $7,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,064
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

CITNB117

Policy instance

Insurance contract or identification number	CITNB117
Number of Individuals Covered	192
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,807
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,807
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP INC

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

Policy contract number

TM05996455

Policy instance

Insurance contract or identification number	TM05996455
Number of Individuals Covered	728
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $39,290
Total amount of fees paid to insurance company	USD $122
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $296,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,290
Amount paid for insurance broker fees	122
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	441
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $61,956
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,956
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

LR512

Policy instance

Insurance contract or identification number	LR512
Number of Individuals Covered	151
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,027
Total amount of fees paid to insurance company	USD $1,146
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,151
Amount paid for insurance broker fees	682
Insurance broker organization code?	3
Insurance broker name	BLAZE J FREMIN

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960660

Policy instance

Insurance contract or identification number	OK 960660
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $921
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $6,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $921
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

2CITNB113

Policy instance

Insurance contract or identification number	2CITNB113
Number of Individuals Covered	165
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,135
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,135
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP INC

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

Policy contract number

TM05996455

Policy instance

Insurance contract or identification number	TM05996455
Number of Individuals Covered	785
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $36,083
Total amount of fees paid to insurance company	USD $66
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $274,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,083
Amount paid for insurance broker fees	66
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

0012334ETAL

Policy instance

Insurance contract or identification number	0012334ETAL
Number of Individuals Covered	401
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $60,116
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,116
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

0000011016

Policy instance

Insurance contract or identification number	0000011016
Number of Individuals Covered	106
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,995
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $175
Insurance broker organization code?	3
Insurance broker name	RICHARD T AKERS

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

Policy contract number

TM05996455

Policy instance

Insurance contract or identification number	TM05996455
Number of Individuals Covered	570
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $36,238
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $251,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,238
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

LR-512

Policy instance

Insurance contract or identification number	LR-512
Number of Individuals Covered	169
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $23,013
Total amount of fees paid to insurance company	USD $792
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,621
Amount paid for insurance broker fees	424
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	NEIL M MORGAN JR.

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $1,000
Other welfare benefits provided	AD & D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,000
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

SDPSCHAJ

Policy instance

Insurance contract or identification number	SDPSCHAJ
Number of Individuals Covered	25
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $840
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $783
Insurance broker organization code?	3
Insurance broker name	LESLIE E SMITH

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

2CITNB113

Policy instance

Insurance contract or identification number	2CITNB113
Number of Individuals Covered	158
Insurance policy start date	2014-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,135
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,135
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGMENT GROUP INC

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

12334 AND 12335

Policy instance

Insurance contract or identification number	12334 AND 12335
Number of Individuals Covered	417
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $63,134
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,134
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

0000011016

Policy instance

Insurance contract or identification number	0000011016
Number of Individuals Covered	106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,221
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $210
Insurance broker organization code?	3
Insurance broker name	RICHARD AKERS

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

Policy contract number

TM05996455

Policy instance

Insurance contract or identification number	TM05996455
Number of Individuals Covered	758
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $31,873
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $287,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,873
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

2CITNB113

Policy instance

Insurance contract or identification number	2CITNB113
Number of Individuals Covered	157
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,159
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,159
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGMENT GROUP INC

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

Policy contract number

0000011016

Policy instance

Insurance contract or identification number	0000011016
Number of Individuals Covered	106
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $19,535
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $473
Insurance broker organization code?	3
Insurance broker name	RICHARD AKERS

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

Policy contract number

0753412

Policy instance

Insurance contract or identification number	0753412
Number of Individuals Covered	263
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $50,007
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,666,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,007
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

SDPSCHAJ

Policy instance

Insurance contract or identification number	SDPSCHAJ
Number of Individuals Covered	30
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,924
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $13,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,867
Insurance broker organization code?	3
Insurance broker name	LESLIE E SMITH

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $980
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $6,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $980
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

LR-512

Policy instance

Insurance contract or identification number	LR-512
Number of Individuals Covered	189
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,637
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,605
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	CAROLINE C HARMON

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

Policy contract number

00001D015461 00

Policy instance

Insurance contract or identification number	00001D015461 00
Number of Individuals Covered	180
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,833
Total amount of fees paid to insurance company	USD $638
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,833
Amount paid for insurance broker fees	638
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

SDPSCHAJ

Policy instance

Insurance contract or identification number	SDPSCHAJ
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,940
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $26,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,819
Insurance broker organization code?	3
Insurance broker name	LESLIE E SMITH

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

Policy contract number

0000011016

Policy instance

Insurance contract or identification number	0000011016
Number of Individuals Covered	96
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $20,379
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,861
Insurance broker name	BRANDY POLIZZI

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $939
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $6,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $939
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

237745

Policy instance

Insurance contract or identification number	237745
Number of Individuals Covered	129
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,690
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,690
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

000400075707 00

Policy instance

Insurance contract or identification number	000400075707 00
Number of Individuals Covered	97
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,779
Total amount of fees paid to insurance company	USD $730
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $38,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,779
Amount paid for insurance broker fees	730
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

42848

Policy instance

Insurance contract or identification number	42848
Number of Individuals Covered	374
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $50,796
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,796
Additional information about fees paid to insurance broker	MANAGEMENT
Insurance broker organization code?	3
Insurance broker name	ROBERT SANFORD

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

Policy contract number

000010076376 00

Policy instance

Insurance contract or identification number	000010076376 00
Number of Individuals Covered	292
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,335
Total amount of fees paid to insurance company	USD $975
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,335
Amount paid for insurance broker fees	975
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

000010076375 00

Policy instance

Insurance contract or identification number	000010076375 00
Number of Individuals Covered	292
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,431
Total amount of fees paid to insurance company	USD $1,315
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $54,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,431
Amount paid for insurance broker fees	1315
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

LR-512

Policy instance

Insurance contract or identification number	LR-512
Number of Individuals Covered	170
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,529
Total amount of fees paid to insurance company	USD $629
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,621
Amount paid for insurance broker fees	49
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Insurance broker name	ROBERT BRIDGES

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

Policy contract number

000400075707 00

Policy instance

Insurance contract or identification number	000400075707 00
Number of Individuals Covered	96
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,478
Total amount of fees paid to insurance company	USD $1,459
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

SDPSCHAJ

Policy instance

Insurance contract or identification number	SDPSCHAJ
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,707
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Number of Individuals Covered	297
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,088
Other welfare benefits provided	AD & D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

237745

Policy instance

Insurance contract or identification number	237745
Number of Individuals Covered	131
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,668
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

42848

Policy instance

Insurance contract or identification number	42848
Number of Individuals Covered	361
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $52,360
Total amount of fees paid to insurance company	USD $43,226
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010076376 00

Policy instance

Insurance contract or identification number	000010076376 00
Number of Individuals Covered	298
Insurance policy start date	2011-01-02
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,311
Total amount of fees paid to insurance company	USD $1,973
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010076375 00

Policy instance

Insurance contract or identification number	000010076375 00
Number of Individuals Covered	299
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,575
Total amount of fees paid to insurance company	USD $2,637
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
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

00001D015461 00

Policy instance

Insurance contract or identification number	00001D015461 00
Number of Individuals Covered	185
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,762
Total amount of fees paid to insurance company	USD $1,237
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LR-512

Policy instance

Insurance contract or identification number	LR-512
Number of Individuals Covered	299
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $30,149
Total amount of fees paid to insurance company	USD $1,136
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

SDPSCHAJ

Policy instance

Insurance contract or identification number	SDPSCHAJ
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,592
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $10,720
Commission paid to Insurance Broker	USD $1,535
Insurance broker organization code?	3
Insurance broker name	WILLIAM P THOMAS

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 960669

Policy instance

Insurance contract or identification number	OK 960669
Number of Individuals Covered	200
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,188
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $7,919
Commission paid to Insurance Broker	USD $1,188
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

237745

Policy instance

Insurance contract or identification number	237745
Number of Individuals Covered	121
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,473
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,732
Commission paid to Insurance Broker	USD $1,473
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

000010076375 00

Policy instance

Insurance contract or identification number	000010076375 00
Number of Individuals Covered	360
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,861
Total amount of fees paid to insurance company	USD $2,075
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $58,609
Commission paid to Insurance Broker	USD $5,861
Amount paid for insurance broker fees	2075
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

42848

Policy instance

Insurance contract or identification number	42848
Number of Individuals Covered	362
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $39,206
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $39,206
Insurance broker organization code?	3
Insurance broker name	ROBERT SANFORD

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

Policy contract number

000010076376 00

Policy instance

Insurance contract or identification number	000010076376 00
Number of Individuals Covered	313
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,577
Total amount of fees paid to insurance company	USD $1,713
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,849
Commission paid to Insurance Broker	USD $6,577
Amount paid for insurance broker fees	1713
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

000400075707 00

Policy instance

Insurance contract or identification number	000400075707 00
Number of Individuals Covered	201
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,863
Total amount of fees paid to insurance company	USD $1,309
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $32,422
Commission paid to Insurance Broker	USD $4,863
Amount paid for insurance broker fees	1309
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

00001D015461 00

Policy instance

Insurance contract or identification number	00001D015461 00
Number of Individuals Covered	191
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,995
Total amount of fees paid to insurance company	USD $1,150
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,948
Commission paid to Insurance Broker	USD $10,995
Amount paid for insurance broker fees	1150
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS MANAGEMENT GROUP

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

Policy contract number

LR-512

Policy instance

Insurance contract or identification number	LR-512
Number of Individuals Covered	201
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $34,065
Total amount of fees paid to insurance company	USD $694
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,546
Commission paid to Insurance Broker	USD $9,882
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	DAVID CLOUD JR

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Company Name:	CITIZENS NATIONAL BANK OF MERIDIAN
Employer identification number (EIN):	640134521
NAIC Classification:	522110
NAIC Description:	Commercial Banking