401k Plan data: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN plan

LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN
Plan identification number	501

LONE STAR NATIONAL BANK EMPLOYEE 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) Prepaid legal Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

LONE STAR NATIONAL BANK has sponsored the creation of one or more 401k plans.

Company Name: LONE STAR NATIONAL BANK

Employer identification number (EIN): 742237409

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 DAVID M. PENOLI
501 2016-01-01 DAVID M. PENOLI
501 2015-01-01 GEORGE CARRUTHERS
501 2014-01-01 GEORGE CARRUTHERS
501 2013-01-01 GEORGE CARRUTHERS
501 2012-01-01 GEORGE CARRUTHERS
501 2011-01-01 GEORGE CARRUTHERS
501 2009-01-01 GEORGE CARRUTHERS

Plan Statistics for LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 517
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 491
Total of all active and inactive participants 2022-01-01 491
Total participants 2022-01-01 491
2021: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 496
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 517
Total of all active and inactive participants 2021-01-01 517
Total participants 2021-01-01 517
2020: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 559
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 496
Total of all active and inactive participants 2020-01-01 496
Total participants 2020-01-01 496
2019: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 552
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 559
Total of all active and inactive participants 2019-01-01 559
Total participants 2019-01-01 559
2018: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 552
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 552
Total of all active and inactive participants 2018-01-01 552
Total participants 2018-01-01 552
2017: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 535
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 552
Total of all active and inactive participants 2017-01-01 552
Total participants 2017-01-01 552
2016: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 533
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 535
Total of all active and inactive participants 2016-01-01 535
Total participants 2016-01-01 535
2015: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 541
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 533
Total of all active and inactive participants 2015-01-01 533
Total participants 2015-01-01 0
2014: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 496
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 541
Total of all active and inactive participants 2014-01-01 541
Total participants 2014-01-01 0
2013: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 424
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 496
Total of all active and inactive participants 2013-01-01 496
Total participants 2013-01-01 0
2012: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 383
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 424
Total of all active and inactive participants 2012-01-01 424
Total participants 2012-01-01 0
2011: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 383
Total of all active and inactive participants 2011-01-01 383
Total participants 2011-01-01 383
2009: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 300
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 324
Total of all active and inactive participants 2009-01-01 324
Total participants 2009-01-01 324

Measure	Date	Value
2022: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	517
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	491
Total of all active and inactive participants	2022-01-01	491
Total participants	2022-01-01	491
2021: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	496
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	517
Total of all active and inactive participants	2021-01-01	517
Total participants	2021-01-01	517
2020: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	559
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	496
Total of all active and inactive participants	2020-01-01	496
Total participants	2020-01-01	496
2019: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	552
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	559
Total of all active and inactive participants	2019-01-01	559
Total participants	2019-01-01	559
2018: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	552
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	552
Total of all active and inactive participants	2018-01-01	552
Total participants	2018-01-01	552
2017: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	535
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	552
Total of all active and inactive participants	2017-01-01	552
Total participants	2017-01-01	552
2016: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	533
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	535
Total of all active and inactive participants	2016-01-01	535
Total participants	2016-01-01	535
2015: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	541
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	533
Total of all active and inactive participants	2015-01-01	533
Total participants	2015-01-01	0
2014: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	496
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	541
Total of all active and inactive participants	2014-01-01	541
Total participants	2014-01-01	0
2013: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	424
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	496
Total of all active and inactive participants	2013-01-01	496
Total participants	2013-01-01	0
2012: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	424
Total of all active and inactive participants	2012-01-01	424
Total participants	2012-01-01	0
2011: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	383
Total of all active and inactive participants	2011-01-01	383
Total participants	2011-01-01	383
2009: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	300
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	324
Total of all active and inactive participants	2009-01-01	324
Total participants	2009-01-01	324

Financial Data on LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN

Measure	Date	Value
2016 : LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2016 401k financial data
Value of total assets at end of year	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in common/collective trusts at end of year	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
2015 : LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2015 401k financial data
Value of total assets at end of year	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	No
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
2014 : LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2014 401k financial data
Value of total assets at end of year	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	No
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No

Form 5500 Responses for LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN

2022: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: LONE STAR NATIONAL BANK EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: LONE STAR NATIONAL BANK EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-055306

Policy instance

Insurance contract or identification number	010-055306
Number of Individuals Covered	415
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $32,212
Total amount of fees paid to insurance company	USD $9,001
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	LASIK, HEARING
Welfare Benefit Premiums Paid to Carrier	USD $322,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,212
Amount paid for insurance broker fees	9001
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	224
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $29,267
Total amount of fees paid to insurance company	USD $2,231
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL CRITICAL ILLNESS / ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $205,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,725
Insurance broker organization code?	3
Amount paid for insurance broker fees	657
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES

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

Policy contract number

400264503

Policy instance

Insurance contract or identification number	400264503
Number of Individuals Covered	439
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $33,070
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $165,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,070
Insurance broker organization code?	3

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

Policy contract number

10264500

Policy instance

Insurance contract or identification number	10264500
Number of Individuals Covered	614
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,848
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $58,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,848
Insurance broker organization code?	3

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

Policy contract number

10264501

Policy instance

Insurance contract or identification number	10264501
Number of Individuals Covered	614
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,063
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $60,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,063
Insurance broker organization code?	3

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

Policy contract number

403007865

Policy instance

Insurance contract or identification number	403007865
Number of Individuals Covered	478
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,123
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,123
Insurance broker organization code?	3

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

Policy contract number

10264502

Policy instance

Insurance contract or identification number	10264502
Number of Individuals Covered	357
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,368
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,368
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	239
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $38,634
Total amount of fees paid to insurance company	USD $17,794
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $211,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,680
Insurance broker organization code?	3
Amount paid for insurance broker fees	12803
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

132108

Policy instance

Insurance contract or identification number	132108
Number of Individuals Covered	32
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $50
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $453
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
Insurance broker organization code?	4

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-055306

Policy instance

Insurance contract or identification number	010-055306
Number of Individuals Covered	402
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $26,376
Total amount of fees paid to insurance company	USD $1,452
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $263,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,376
Amount paid for insurance broker fees	1452
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

10264500

Policy instance

Insurance contract or identification number	10264500
Number of Individuals Covered	609
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,769
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,769
Insurance broker organization code?	3

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

Policy contract number

403007865

Policy instance

Insurance contract or identification number	403007865
Number of Individuals Covered	462
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,338
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $31,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,338
Insurance broker organization code?	3

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

Policy contract number

10264502

Policy instance

Insurance contract or identification number	10264502
Number of Individuals Covered	370
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,113
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,113
Insurance broker organization code?	3

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

Policy contract number

400264503

Policy instance

Insurance contract or identification number	400264503
Number of Individuals Covered	410
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $30,690
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $153,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,690
Insurance broker organization code?	3

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

Policy contract number

10264501

Policy instance

Insurance contract or identification number	10264501
Number of Individuals Covered	609
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,869
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $58,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,869
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	238
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $52,169
Total amount of fees paid to insurance company	USD $8,221
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $200,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,276
Insurance broker organization code?	3
Amount paid for insurance broker fees	2363
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

132108

Policy instance

Insurance contract or identification number	132108
Number of Individuals Covered	34
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,025
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $6,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $871
Insurance broker organization code?	4

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

Policy contract number

GVTL0B8RB

Policy instance

Insurance contract or identification number	GVTL0B8RB
Number of Individuals Covered	337
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $24,011
Total amount of fees paid to insurance company	USD $4,308
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $120,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,011
Amount paid for insurance broker fees	4308
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0B8RB

Policy instance

Insurance contract or identification number	GLTD0B8RB
Number of Individuals Covered	598
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,165
Total amount of fees paid to insurance company	USD $1,673
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,165
Amount paid for insurance broker fees	1673
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0B8RB

Policy instance

Insurance contract or identification number	GLUG0B8RB
Number of Individuals Covered	598
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,528
Total amount of fees paid to insurance company	USD $2,172
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $55,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,528
Amount paid for insurance broker fees	2172
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0B8RB

Policy instance

Insurance contract or identification number	GMDC0B8RB
Number of Individuals Covered	891
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,936
Total amount of fees paid to insurance company	USD $742
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,936
Amount paid for insurance broker fees	742
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUC 0B8RB

Policy instance

Insurance contract or identification number	GUC 0B8RB
Number of Individuals Covered	328
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $17,711
Total amount of fees paid to insurance company	USD $3,474
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,711
Amount paid for insurance broker fees	3474
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

5948250

Policy instance

Insurance contract or identification number	5948250
Number of Individuals Covered	748
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $31,759
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $266,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,759
Insurance broker organization code?	3

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

Policy contract number

GUC 0B8RB

Policy instance

Insurance contract or identification number	GUC 0B8RB
Number of Individuals Covered	347
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $18,489
Total amount of fees paid to insurance company	USD $5,493
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,489
Amount paid for insurance broker fees	5493
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0B8RB

Policy instance

Insurance contract or identification number	GMDC0B8RB
Number of Individuals Covered	559
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,965
Total amount of fees paid to insurance company	USD $583
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,965
Amount paid for insurance broker fees	583
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0B8RB

Policy instance

Insurance contract or identification number	GLUG0B8RB
Number of Individuals Covered	559
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,750
Total amount of fees paid to insurance company	USD $3,673
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $57,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,750
Amount paid for insurance broker fees	3673
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

5948250

Policy instance

Insurance contract or identification number	5948250
Number of Individuals Covered	538
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $20,186
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $295,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,186
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

132108

Policy instance

Insurance contract or identification number	132108
Number of Individuals Covered	32
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $383
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $4,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $326
Insurance broker organization code?	4

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	213
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,374
Total amount of fees paid to insurance company	USD $4,707
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $161,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,696
Insurance broker organization code?	3
Amount paid for insurance broker fees	1380
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES

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

Policy contract number

GVTL0B8RB

Policy instance

Insurance contract or identification number	GVTL0B8RB
Number of Individuals Covered	363
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,939
Total amount of fees paid to insurance company	USD $7,743
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $114,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,939
Amount paid for insurance broker fees	7743
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0B8RB

Policy instance

Insurance contract or identification number	GLTD0B8RB
Number of Individuals Covered	559
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,691
Total amount of fees paid to insurance company	USD $2,877
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,691
Amount paid for insurance broker fees	2877
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

132108

Policy instance

Insurance contract or identification number	132108
Number of Individuals Covered	31
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $922
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $3,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $833
Insurance broker organization code?	4

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

Policy contract number

GVTL0B8RB

Policy instance

Insurance contract or identification number	GVTL0B8RB
Number of Individuals Covered	371
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $22,471
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $112,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,471
Insurance broker organization code?	3

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

Policy contract number

GUC 0B8RB

Policy instance

Insurance contract or identification number	GUC 0B8RB
Number of Individuals Covered	318
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,652
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,652
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0B8RB

Policy instance

Insurance contract or identification number	GMDC0B8RB
Number of Individuals Covered	414
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $634
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $634
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	207
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $25,726
Total amount of fees paid to insurance company	USD $8,271
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $154,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,159
Amount paid for insurance broker fees	4224
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3

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

Policy contract number

GLUG0B8RB

Policy instance

Insurance contract or identification number	GLUG0B8RB
Number of Individuals Covered	625
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,927
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $59,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,927
Insurance broker organization code?	3

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

Policy contract number

GLTD0B8RB

Policy instance

Insurance contract or identification number	GLTD0B8RB
Number of Individuals Covered	625
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,787
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,787
Insurance broker organization code?	3

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

Policy contract number

5948250

Policy instance

Insurance contract or identification number	5948250
Number of Individuals Covered	832
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $26,623
Total amount of fees paid to insurance company	USD $90
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $292,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,623
Amount paid for insurance broker fees	90
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

132108

Policy instance

Insurance contract or identification number	132108
Number of Individuals Covered	22
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,502
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $3,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,362
Insurance broker organization code?	4
Insurance broker name	GAYLE M TRUDEAU

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

Policy contract number

000400184260

Policy instance

Insurance contract or identification number	000400184260
Number of Individuals Covered	350
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $18,266
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $91,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,266
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000403002740

Policy instance

Insurance contract or identification number	000403002740
Number of Individuals Covered	333
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,212
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,212
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184261

Policy instance

Insurance contract or identification number	000010184261
Number of Individuals Covered	287
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $15,431
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,431
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184259

Policy instance

Insurance contract or identification number	000010184259
Number of Individuals Covered	615
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,692
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,692
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184258

Policy instance

Insurance contract or identification number	000010184258
Number of Individuals Covered	615
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,695
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $76,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,695
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	200
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $27,145
Total amount of fees paid to insurance company	USD $10,097
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $157,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,284
Insurance broker organization code?	3
Amount paid for insurance broker fees	8511
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker name	BRUCE D AKERS

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-040453

Policy instance

Insurance contract or identification number	010-040453
Number of Individuals Covered	917
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,578
Total amount of fees paid to insurance company	USD $1,029
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $257,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,578
Amount paid for insurance broker fees	1029
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

UFLIC FBO AMTRUST FINANCIAL (National Association of Insurance Commissioners NAIC id number: 82538 )

Policy contract number

WAH107872700

Policy instance

Insurance contract or identification number	WAH107872700
Number of Individuals Covered	546
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $47,433
Total amount of fees paid to insurance company	USD $602,986
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	TPA
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	426890
Additional information about fees paid to insurance broker	STOP LOSS CARRIER
Insurance broker organization code?	0
Commission paid to Insurance Broker	USD $47,433
Insurance broker name	FIRST HEALTH CORP

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

Policy contract number

000403002740

Policy instance

Insurance contract or identification number	000403002740
Number of Individuals Covered	294
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,487
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,487
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184261

Policy instance

Insurance contract or identification number	000010184261
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,728
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,728
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184259

Policy instance

Insurance contract or identification number	000010184259
Number of Individuals Covered	609
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,368
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,368
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184258

Policy instance

Insurance contract or identification number	000010184258
Number of Individuals Covered	609
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,132
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $71,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,132
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

UFLIC FBO AMTRUST FINANCIAL (National Association of Insurance Commissioners NAIC id number: 82538 )

Policy contract number

WAH107872700

Policy instance

Insurance contract or identification number	WAH107872700
Number of Individuals Covered	559
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $714,031
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	481690
Additional information about fees paid to insurance broker	STOP LOSS CARRIER
Insurance broker organization code?	0
Insurance broker name	FIRST HEALTH CORP

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

Policy contract number

000400184260

Policy instance

Insurance contract or identification number	000400184260
Number of Individuals Covered	282
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,166
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $70,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,166
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-040453

Policy instance

Insurance contract or identification number	010-040453
Number of Individuals Covered	1023
Insurance policy start date	2015-03-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $977
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	977
Additional information about fees paid to insurance broker	BONUS & NON CASH INSENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	317
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $32,035
Total amount of fees paid to insurance company	USD $11,645
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $136,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,295
Insurance broker organization code?	3
Amount paid for insurance broker fees	8920
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker name	ROBERT SWINNEA

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

Policy contract number

000010184261

Policy instance

Insurance contract or identification number	000010184261
Number of Individuals Covered	238
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,501
Total amount of fees paid to insurance company	USD $2,976
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,501
Amount paid for insurance broker fees	2976
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-040453

Policy instance

Insurance contract or identification number	010-040453
Number of Individuals Covered	1552
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of fees paid to insurance company	USD $1,120
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1120
Additional information about fees paid to insurance broker	BONUS & NON CASH INSENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

UFLIC FBO AMTRUST FINANCIAL (National Association of Insurance Commissioners NAIC id number: 82538 )

Policy contract number

WAH107872700

Policy instance

Insurance contract or identification number	WAH107872700
Number of Individuals Covered	543
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $574,255
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	363424
Additional information about fees paid to insurance broker	STOP LOSS CARRIER
Insurance broker organization code?	0
Insurance broker name	FIRST HEALTH CORP

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4212817

Policy instance

Insurance contract or identification number	E4212817
Number of Individuals Covered	267
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $92,909
Total amount of fees paid to insurance company	USD $35,321
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $150,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,270
Insurance broker organization code?	3
Amount paid for insurance broker fees	25671
Insurance broker name	ROBERT SWINNEA

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

Policy contract number

000010184258

Policy instance

Insurance contract or identification number	000010184258
Number of Individuals Covered	610
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,240
Total amount of fees paid to insurance company	USD $3,082
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $62,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,240
Amount paid for insurance broker fees	3082
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

1040397

Policy instance

Insurance contract or identification number	1040397
Number of Individuals Covered	886
Insurance policy start date	2014-01-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $688
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $688
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

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

Policy contract number

000400184260

Policy instance

Insurance contract or identification number	000400184260
Number of Individuals Covered	247
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $13,870
Total amount of fees paid to insurance company	USD $3,489
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $69,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,870
Amount paid for insurance broker fees	3489
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000010184259

Policy instance

Insurance contract or identification number	000010184259
Number of Individuals Covered	610
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,856
Total amount of fees paid to insurance company	USD $1,893
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,856
Amount paid for insurance broker fees	1893
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

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

Policy contract number

000403002740

Policy instance

Insurance contract or identification number	000403002740
Number of Individuals Covered	159
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,369
Total amount of fees paid to insurance company	USD $299
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,369
Amount paid for insurance broker fees	299
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVCS INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

835836

Policy instance

Insurance contract or identification number	835836
Number of Individuals Covered	1351
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,858
Total amount of fees paid to insurance company	USD $286
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $94,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,858
Amount paid for insurance broker fees	286
Additional information about fees paid to insurance broker	2012 SPECIALTY CROSS SALE
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

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

Policy contract number

R0393173

Policy instance

Insurance contract or identification number	R0393173
Number of Individuals Covered	346
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $34,567
Total amount of fees paid to insurance company	USD $890
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $96,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,567
Amount paid for insurance broker fees	890
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

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

Policy contract number

4045110010

Policy instance

Insurance contract or identification number	4045110010
Number of Individuals Covered	473
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Welfare Benefit Premiums Paid to Carrier	USD $407,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

MG-124 OP121846

Policy instance

Insurance contract or identification number	MG-124 OP121846
Number of Individuals Covered	90
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,629
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,629
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES, INC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0009242070

Policy instance

Insurance contract or identification number	0009242070
Number of Individuals Covered	249
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $28,248
Total amount of fees paid to insurance company	USD $1,109
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,248
Amount paid for insurance broker fees	151
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	GREG L REICH

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0009242070

Policy instance

Insurance contract or identification number	0009242070
Number of Individuals Covered	111
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $18,765
Total amount of fees paid to insurance company	USD $1,310
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,765
Amount paid for insurance broker fees	1310
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES, INC.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

835836

Policy instance

Insurance contract or identification number	835836
Number of Individuals Covered	757
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,909
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $84,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,909
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SVS INC

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

Policy contract number

R0393173

Policy instance

Insurance contract or identification number	R0393173
Number of Individuals Covered	141
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $34,871
Total amount of fees paid to insurance company	USD $9
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $49,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,871
Amount paid for insurance broker fees	9
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	LONE STAR INSURANCE SERVICES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3309275

Policy instance

Insurance contract or identification number	E3309275
Number of Individuals Covered	333
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,135
Total amount of fees paid to insurance company	USD $822
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,396
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	BONUS & NON CASH INCENTIVES
Insurance broker name	LSNB INSURANCE SERVICES, INC

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

Policy contract number

HCL16949

Policy instance

Insurance contract or identification number	HCL16949
Number of Individuals Covered	383
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Welfare Benefit Premiums Paid to Carrier	USD $354,521
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

000010123962

Policy instance

Insurance contract or identification number	000010123962
Number of Individuals Covered	482
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,638
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,721
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

000010123963

Policy instance

Insurance contract or identification number	000010123963
Number of Individuals Covered	479
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,456
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3309275

Policy instance

Insurance contract or identification number	E3309275
Number of Individuals Covered	339
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $61,556
Total amount of fees paid to insurance company	USD $12,647
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $274,022
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

000010123962

Policy instance

Insurance contract or identification number	000010123962
Number of Individuals Covered	453
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,649
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,896
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

000010123963

Policy instance

Insurance contract or identification number	000010123963
Number of Individuals Covered	450
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,482
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16949

Policy instance

Insurance contract or identification number	HCL16949
Number of Individuals Covered	360
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Welfare Benefit Premiums Paid to Carrier	USD $332,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3309275

Policy instance

Insurance contract or identification number	E3309275
Number of Individuals Covered	296
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $65,290
Total amount of fees paid to insurance company	USD $7,730
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

699500G

Policy instance

Insurance contract or identification number	699500G
Number of Individuals Covered	410
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $328
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LONE STAR NATIONAL BANK
Employer identification number (EIN):	742237409
NAIC Classification:	522110
NAIC Description:	Commercial Banking