401k Plan data: VICTORY CHRISTIAN CENTER, INC. plan

VICTORY CHRISTIAN CENTER, INC. 401k Plan overview

Plan Name	VICTORY CHRISTIAN CENTER, INC.
Plan identification number	505

VICTORY CHRISTIAN CENTER, 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

401k Sponsoring company profile

VICTORY CHRISTIAN CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: VICTORY CHRISTIAN CENTER, INC.

Employer identification number (EIN): 731118610

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about VICTORY CHRISTIAN CENTER, INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 1985-08-05

Company Identification Number: C1282972

Legal Registered Office Address: 1740 Puma Crossing

Placerville
United States of America (USA)
95667

More information about VICTORY CHRISTIAN CENTER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VICTORY CHRISTIAN CENTER, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2021-07-01
505 2020-07-01
505 2019-07-01
505 2018-07-01
505 2017-07-01
505 2016-07-01 JEFFERY D. GEUDER
505 2015-07-01 JEFFERY D. GEUDER
505 2014-07-01 BILL WELLS
505 2012-07-01 BILL WELLS
505 2011-07-01 BILL WELLS
505 2009-07-01 BILL WELLS

Plan Statistics for VICTORY CHRISTIAN CENTER, INC.

401k plan membership statisitcs for VICTORY CHRISTIAN CENTER, INC.

Measure Date Value
2021: VICTORY CHRISTIAN CENTER, INC. 2021 401k membership
Total participants, beginning-of-year 2021-07-01 704
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 702
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 702
2020: VICTORY CHRISTIAN CENTER, INC. 2020 401k membership
Total participants, beginning-of-year 2020-07-01 694
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 704
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 704
2019: VICTORY CHRISTIAN CENTER, INC. 2019 401k membership
Total participants, beginning-of-year 2019-07-01 732
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 694
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 694
2018: VICTORY CHRISTIAN CENTER, INC. 2018 401k membership
Total participants, beginning-of-year 2018-07-01 678
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 732
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 732
2017: VICTORY CHRISTIAN CENTER, INC. 2017 401k membership
Total participants, beginning-of-year 2017-07-01 272
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 678
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 678
2016: VICTORY CHRISTIAN CENTER, INC. 2016 401k membership
Total participants, beginning-of-year 2016-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 272
Total of all active and inactive participants 2016-07-01 272
Total participants 2016-07-01 272
2015: VICTORY CHRISTIAN CENTER, INC. 2015 401k membership
Total participants, beginning-of-year 2015-07-01 198
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 202
Number of retired or separated participants receiving benefits 2015-07-01 3
Total of all active and inactive participants 2015-07-01 205
Total participants 2015-07-01 0
2014: VICTORY CHRISTIAN CENTER, INC. 2014 401k membership
Total participants, beginning-of-year 2014-07-01 205
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 197
Number of retired or separated participants receiving benefits 2014-07-01 1
Total of all active and inactive participants 2014-07-01 198
Total participants 2014-07-01 0
2012: VICTORY CHRISTIAN CENTER, INC. 2012 401k membership
Total participants, beginning-of-year 2012-07-01 255
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 243
Number of retired or separated participants receiving benefits 2012-07-01 1
Total of all active and inactive participants 2012-07-01 244
Total participants 2012-07-01 0
2011: VICTORY CHRISTIAN CENTER, INC. 2011 401k membership
Total participants, beginning-of-year 2011-07-01 251
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 255
Number of retired or separated participants receiving benefits 2011-07-01 2
Total of all active and inactive participants 2011-07-01 257
Total participants 2011-07-01 257
2009: VICTORY CHRISTIAN CENTER, INC. 2009 401k membership
Total participants, beginning-of-year 2009-07-01 293
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 280
Number of retired or separated participants receiving benefits 2009-07-01 1
Total of all active and inactive participants 2009-07-01 281
Total participants 2009-07-01 281

Measure	Date	Value
2021: VICTORY CHRISTIAN CENTER, INC. 2021 401k membership
Total participants, beginning-of-year	2021-07-01	704
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	702
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	702
2020: VICTORY CHRISTIAN CENTER, INC. 2020 401k membership
Total participants, beginning-of-year	2020-07-01	694
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	704
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	704
2019: VICTORY CHRISTIAN CENTER, INC. 2019 401k membership
Total participants, beginning-of-year	2019-07-01	732
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	694
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	694
2018: VICTORY CHRISTIAN CENTER, INC. 2018 401k membership
Total participants, beginning-of-year	2018-07-01	678
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	732
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	732
2017: VICTORY CHRISTIAN CENTER, INC. 2017 401k membership
Total participants, beginning-of-year	2017-07-01	272
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	678
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	678
2016: VICTORY CHRISTIAN CENTER, INC. 2016 401k membership
Total participants, beginning-of-year	2016-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	272
Total of all active and inactive participants	2016-07-01	272
Total participants	2016-07-01	272
2015: VICTORY CHRISTIAN CENTER, INC. 2015 401k membership
Total participants, beginning-of-year	2015-07-01	198
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	202
Number of retired or separated participants receiving benefits	2015-07-01	3
Total of all active and inactive participants	2015-07-01	205
Total participants	2015-07-01	0
2014: VICTORY CHRISTIAN CENTER, INC. 2014 401k membership
Total participants, beginning-of-year	2014-07-01	205
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	197
Number of retired or separated participants receiving benefits	2014-07-01	1
Total of all active and inactive participants	2014-07-01	198
Total participants	2014-07-01	0
2012: VICTORY CHRISTIAN CENTER, INC. 2012 401k membership
Total participants, beginning-of-year	2012-07-01	255
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	243
Number of retired or separated participants receiving benefits	2012-07-01	1
Total of all active and inactive participants	2012-07-01	244
Total participants	2012-07-01	0
2011: VICTORY CHRISTIAN CENTER, INC. 2011 401k membership
Total participants, beginning-of-year	2011-07-01	251
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	255
Number of retired or separated participants receiving benefits	2011-07-01	2
Total of all active and inactive participants	2011-07-01	257
Total participants	2011-07-01	257
2009: VICTORY CHRISTIAN CENTER, INC. 2009 401k membership
Total participants, beginning-of-year	2009-07-01	293
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	280
Number of retired or separated participants receiving benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	281
Total participants	2009-07-01	281

Financial Data on VICTORY CHRISTIAN CENTER, INC.

Measure	Date	Value
2022 : VICTORY CHRISTIAN CENTER, INC. 2022 401k financial data
Total income from all sources	2022-06-30	$0
Total plan assets at end of year	2022-06-30	$0
Total plan assets at beginning of year	2022-06-30	$0
Net plan assets at end of year (total assets less liabilities)	2022-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2022-06-30	$0
2021 : VICTORY CHRISTIAN CENTER, INC. 2021 401k financial data
Total income from all sources	2021-06-30	$0
Total plan assets at end of year	2021-06-30	$0
Total plan assets at beginning of year	2021-06-30	$0
Net plan assets at end of year (total assets less liabilities)	2021-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2021-06-30	$0
2020 : VICTORY CHRISTIAN CENTER, INC. 2020 401k financial data
Total income from all sources	2020-06-30	$0
Total plan assets at end of year	2020-06-30	$0
Total plan assets at beginning of year	2020-06-30	$0
Net plan assets at end of year (total assets less liabilities)	2020-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2020-06-30	$0
2019 : VICTORY CHRISTIAN CENTER, INC. 2019 401k financial data
Total income from all sources	2019-06-30	$0
Total plan assets at end of year	2019-06-30	$0
Total plan assets at beginning of year	2019-06-30	$0
Net plan assets at end of year (total assets less liabilities)	2019-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-06-30	$0

Form 5500 Responses for VICTORY CHRISTIAN CENTER, INC.

2021: VICTORY CHRISTIAN CENTER, INC. 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: VICTORY CHRISTIAN CENTER, INC. 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: VICTORY CHRISTIAN CENTER, INC. 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: VICTORY CHRISTIAN CENTER, INC. 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: VICTORY CHRISTIAN CENTER, INC. 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: VICTORY CHRISTIAN CENTER, INC. 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: VICTORY CHRISTIAN CENTER, INC. 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: VICTORY CHRISTIAN CENTER, INC. 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2012: VICTORY CHRISTIAN CENTER, INC. 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: VICTORY CHRISTIAN CENTER, INC. 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2009: VICTORY CHRISTIAN CENTER, INC. 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

30063937

Policy instance

Insurance contract or identification number	30063937
Number of Individuals Covered	143
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,053
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 $1,053
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219

Policy instance

Insurance contract or identification number	8219
Number of Individuals Covered	192
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $6,640
Total amount of fees paid to insurance company	USD $12,327
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,640
Amount paid for insurance broker fees	12327
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	452
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of fees paid to insurance company	USD $90,965
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,373,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	90965
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3

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

Policy contract number

000010222556

Policy instance

Insurance contract or identification number	000010222556
Number of Individuals Covered	276
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,747
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,747
Insurance broker organization code?	3

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

Policy contract number

000010222557

Policy instance

Insurance contract or identification number	000010222557
Number of Individuals Covered	277
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,941
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,941
Insurance broker organization code?	3

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

Policy contract number

000010222555

Policy instance

Insurance contract or identification number	000010222555
Number of Individuals Covered	275
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,233
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,233
Insurance broker organization code?	3

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

Policy contract number

000403005876

Policy instance

Insurance contract or identification number	000403005876
Number of Individuals Covered	187
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $357
Other welfare benefits provided	SPOUSE/CHILD AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $32,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $357
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C07003

Policy instance

Insurance contract or identification number	C07003
Number of Individuals Covered	250
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

0004000010000

Policy instance

Insurance contract or identification number	0004000010000
Number of Individuals Covered	241
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,905
Other welfare benefits provided	SPOUSE/ CHILD AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $29,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,905
Insurance broker organization code?	3

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

Policy contract number

30063937

Policy instance

Insurance contract or identification number	30063937
Number of Individuals Covered	137
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,043
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 $1,043
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219

Policy instance

Insurance contract or identification number	8219
Number of Individuals Covered	188
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $6,339
Total amount of fees paid to insurance company	USD $13,059
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,339
Amount paid for insurance broker fees	13059
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	454
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $88,620
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,273,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,620
Insurance broker organization code?	3

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

Policy contract number

000010222556

Policy instance

Insurance contract or identification number	000010222556
Number of Individuals Covered	261
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $3,133
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,133
Insurance broker organization code?	3

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

Policy contract number

000010222557

Policy instance

Insurance contract or identification number	000010222557
Number of Individuals Covered	262
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,459
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,459
Insurance broker organization code?	3

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

Policy contract number

000010222555

Policy instance

Insurance contract or identification number	000010222555
Number of Individuals Covered	261
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $3,033
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,033
Insurance broker organization code?	3

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

Policy contract number

000403005876

Policy instance

Insurance contract or identification number	000403005876
Number of Individuals Covered	213
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $432
Other welfare benefits provided	SPOUSE/CHILD AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $4,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $432
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C07003

Policy instance

Insurance contract or identification number	C07003
Number of Individuals Covered	250
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $24,853
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $758,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,853
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	265
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $3,252
Other welfare benefits provided	SPOUSE/CHILD LIFE
Welfare Benefit Premiums Paid to Carrier	USD $32,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,252
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219

Policy instance

Insurance contract or identification number	8219
Number of Individuals Covered	191
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,207
Total amount of fees paid to insurance company	USD $14,376
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,207
Amount paid for insurance broker fees	14376
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	444
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $87,780
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,440,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,780
Insurance broker organization code?	3

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

Policy contract number

30063937

Policy instance

Insurance contract or identification number	30063937
Number of Individuals Covered	136
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,007
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 $1,007
Insurance broker organization code?	3

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

Policy contract number

000010222556

Policy instance

Insurance contract or identification number	000010222556
Number of Individuals Covered	252
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,000
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,000
Insurance broker organization code?	3

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

Policy contract number

000010222557

Policy instance

Insurance contract or identification number	000010222557
Number of Individuals Covered	253
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,461
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,461
Insurance broker organization code?	3

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

Policy contract number

000010222555

Policy instance

Insurance contract or identification number	000010222555
Number of Individuals Covered	252
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,643
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,643
Insurance broker organization code?	3

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

Policy contract number

000403005876

Policy instance

Insurance contract or identification number	000403005876
Number of Individuals Covered	206
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $396
Other welfare benefits provided	SPOUSE/CHILD AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $396
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C07003

Policy instance

Insurance contract or identification number	C07003
Number of Individuals Covered	250
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	676
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $90,615
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,187,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $90,615
Insurance broker organization code?	3

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

Policy contract number

30063937

Policy instance

Insurance contract or identification number	30063937
Number of Individuals Covered	127
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,031
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 $1,031
Insurance broker organization code?	3

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

Policy contract number

000010222556

Policy instance

Insurance contract or identification number	000010222556
Number of Individuals Covered	254
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,059
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,059
Insurance broker organization code?	3

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

Policy contract number

000010222557

Policy instance

Insurance contract or identification number	000010222557
Number of Individuals Covered	254
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,673
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,673
Insurance broker organization code?	3

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

Policy contract number

000010222555

Policy instance

Insurance contract or identification number	000010222555
Number of Individuals Covered	255
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,757
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $27,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,757
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	122
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,783
Other welfare benefits provided	SPOUSE/CHILD LIFE
Welfare Benefit Premiums Paid to Carrier	USD $37,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,783
Insurance broker organization code?	3

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

Policy contract number

000403005876

Policy instance

Insurance contract or identification number	000403005876
Number of Individuals Covered	96
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $398
Other welfare benefits provided	SPOUSE/CHILD AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $3,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $398
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219

Policy instance

Insurance contract or identification number	8219
Number of Individuals Covered	191
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,710
Total amount of fees paid to insurance company	USD $14,577
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,710
Amount paid for insurance broker fees	14577
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C07003

Policy instance

Insurance contract or identification number	C07003
Number of Individuals Covered	56
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $10,864
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $243,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,864
Insurance broker organization code?	3

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

Policy contract number

000403005876

Policy instance

Insurance contract or identification number	000403005876
Number of Individuals Covered	87
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $360
Other welfare benefits provided	SPOUSE/CHILD AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219

Policy instance

Insurance contract or identification number	8219
Number of Individuals Covered	209
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $5,375
Total amount of fees paid to insurance company	USD $14,376
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	678
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $93,695
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,359,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30063937

Policy instance

Insurance contract or identification number	30063937
Number of Individuals Covered	123
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,037
Vision 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

000010222556

Policy instance

Insurance contract or identification number	000010222556
Number of Individuals Covered	269
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,674
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,736
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

000010222557

Policy instance

Insurance contract or identification number	000010222557
Number of Individuals Covered	269
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,306
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,064
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

000010222555

Policy instance

Insurance contract or identification number	000010222555
Number of Individuals Covered	268
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,277
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $22,772
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

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	108
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,470
Other welfare benefits provided	SPOUSE/CHILD LIFE
Welfare Benefit Premiums Paid to Carrier	USD $34,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	403
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $1,500
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,500
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

AFASLP2008772

Policy instance

Insurance contract or identification number	AFASLP2008772
Number of Individuals Covered	205
Insurance policy start date	2015-07-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $19,713
Total amount of fees paid to insurance company	USD $1,560
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $131,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,059
Amount paid for insurance broker fees	1560
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	HEALTHCARE SOLUTIONS GROUP, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	403
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $541
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $541
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	403
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $3,961
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,961
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	403
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $8,975
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,975
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219-0001

Policy instance

Insurance contract or identification number	8219-0001
Number of Individuals Covered	187
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $4,733
Total amount of fees paid to insurance company	USD $12,364
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,733
Amount paid for insurance broker fees	12364
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C11226

Policy instance

Insurance contract or identification number	C11226
Number of Individuals Covered	447
Insurance policy start date	2015-11-01
Insurance policy end date	2016-10-31
Total amount of commissions paid to insurance broker	USD $83,615
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,290,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,615
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

AFASLP2008772

Policy instance

Insurance contract or identification number	AFASLP2008772
Number of Individuals Covered	198
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $57,801
Total amount of fees paid to insurance company	USD $7,770
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $424,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,575
Amount paid for insurance broker fees	4770
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3
Insurance broker name	HEALTHCARE SOLUTIONS GROUP, INC.

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219-0001

Policy instance

Insurance contract or identification number	8219-0001
Number of Individuals Covered	177
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,988
Total amount of fees paid to insurance company	USD $12,968
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,988
Amount paid for insurance broker fees	12968
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	394
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $9,504
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,504
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	394
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $3,930
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,930
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	394
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $593
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $593
Insurance broker organization code?	3
Insurance broker name	BENEX, INC.

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	490
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $8,141
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,141
Insurance broker organization code?	3
Insurance broker name	TIMOTHY J. HENDRICKS

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219-0001

Policy instance

Insurance contract or identification number	8219-0001
Number of Individuals Covered	240
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $6,447
Total amount of fees paid to insurance company	USD $14,955
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,447
Amount paid for insurance broker fees	14955
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	TIMOTHY J. HENDRICKS

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	490
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $3,177
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,177
Insurance broker organization code?	3
Insurance broker name	TIMOTHY J. HENDRICKS

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	490
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $537
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $537
Insurance broker organization code?	3
Insurance broker name	TIMOTHY J. HENDRICKS

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

T2843

Policy instance

Insurance contract or identification number	T2843
Number of Individuals Covered	243
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $58,176
Total amount of fees paid to insurance company	USD $5,882
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $523,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,088
Insurance broker organization code?	3
Amount paid for insurance broker fees	5882
Insurance broker name	TIMOTHY HENDRICKS

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	535
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $3,065
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219-0001

Policy instance

Insurance contract or identification number	8219-0001
Number of Individuals Covered	239
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $7,478
Total amount of fees paid to insurance company	USD $13,171
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

T2843

Policy instance

Insurance contract or identification number	T2843
Number of Individuals Covered	255
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $54,248
Total amount of fees paid to insurance company	USD $5,802
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $488,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	535
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $386
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05984739

Policy instance

Insurance contract or identification number	KM05984739
Number of Individuals Covered	535
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $5,408
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

139423

Policy instance

Insurance contract or identification number	139423
Number of Individuals Covered	265
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $2,183
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

8219-0001

Policy instance

Insurance contract or identification number	8219-0001
Number of Individuals Covered	239
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $7,113
Total amount of fees paid to insurance company	USD $15,192
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

T2843

Policy instance

Insurance contract or identification number	T2843
Number of Individuals Covered	251
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $51,120
Total amount of fees paid to insurance company	USD $6,000
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $459,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

139423

Policy instance

Insurance contract or identification number	139423
Number of Individuals Covered	265
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $3,690
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

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Company Name:	VICTORY CHRISTIAN CENTER, INC.
Employer identification number (EIN):	731118610
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	1985-08-05
Company Identification Number:	C1282972
Legal Registered Office Address:	1740 Puma Crossing Placerville United States of America (USA) 95667