401k Plan data: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA plan

REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 401k Plan overview

Plan Name	REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA
Plan identification number	501

REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

REECE SUPPLY COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: REECE SUPPLY COMPANY, INC.

Employer identification number (EIN): 750783034

NAIC Classification: 423600

Additional information about REECE SUPPLY COMPANY, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1950-07-28

Company Identification Number: 0010395600

Legal Registered Office Address: PO BOX 170269

IRVING
United States of America (USA)
75017

More information about REECE SUPPLY COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 ROGER TENNEY 2024-10-11 ROGER TENNEY 2024-10-11
501 2022-01-01 ROGER TENNEY 2023-10-10 ROGER TENNEY 2023-10-10
501 2021-01-01 ROGER TENNEY 2021-10-11 ROGER TENNEY 2021-10-11
501 2020-01-01 ROGER TENNEY 2021-10-14 ROGER TENNEY 2021-10-14
501 2019-01-01 ROGER TENNEY 2020-10-13 ROGER TENNEY 2020-10-13
501 2018-01-01 ROGER L TENNEY 2019-09-19 ROGER L TENNEY 2019-09-19
501 2018-01-01
501 2017-01-01
501 2017-01-01
501 2017-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 RICHARD T. REECE
501 2011-01-01 RICHARD T. REECE
501 2009-01-01 RICHARD T. REECE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	ROGER TENNEY	2024-10-11	ROGER TENNEY	2024-10-11
501	2022-01-01	ROGER TENNEY	2023-10-10	ROGER TENNEY	2023-10-10
501	2021-01-01	ROGER TENNEY	2021-10-11	ROGER TENNEY	2021-10-11
501	2020-01-01	ROGER TENNEY	2021-10-14	ROGER TENNEY	2021-10-14
501	2019-01-01	ROGER TENNEY	2020-10-13	ROGER TENNEY	2020-10-13
501	2018-01-01	ROGER L TENNEY	2019-09-19	ROGER L TENNEY	2019-09-19
501	2018-01-01
501	2017-01-01
501	2017-01-01
501	2017-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	RICHARD T. REECE
501	2011-01-01	RICHARD T. REECE
501	2009-01-01	RICHARD T. REECE

Plan Statistics for REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA

401k plan membership statisitcs for REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA

Measure Date Value
2023: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2023 401k membership
Total participants, beginning-of-year 2023-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 165
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 165
2022: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2022 401k membership
Total participants, beginning-of-year 2022-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 163
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 163
2021: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2021 401k membership
Total participants, beginning-of-year 2021-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 167
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 167
2020: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2020 401k membership
Total participants, beginning-of-year 2020-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 243
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 243
2019: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2019 401k membership
Total participants, beginning-of-year 2019-01-01 237
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 236
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 236
2018: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2018 401k membership
Total participants, beginning-of-year 2018-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 127
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 127
2017: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2017 401k membership
Total participants, beginning-of-year 2017-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 164
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 164
2016: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2016 401k membership
Total participants, beginning-of-year 2016-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 156
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 157
2015: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2015 401k membership
Total participants, beginning-of-year 2015-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 156
Total of all active and inactive participants 2015-01-01 156
2014: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2014 401k membership
Total participants, beginning-of-year 2014-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 156
Total of all active and inactive participants 2014-01-01 156
2013: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2013 401k membership
Total participants, beginning-of-year 2013-01-01 217
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 219
Total of all active and inactive participants 2013-01-01 219
2012: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2012 401k membership
Total participants, beginning-of-year 2012-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 217
Total of all active and inactive participants 2012-01-01 217
2011: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2011 401k membership
Total participants, beginning-of-year 2011-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 211
Total of all active and inactive participants 2011-01-01 211
2009: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2009 401k membership
Total participants, beginning-of-year 2009-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 163
Total of all active and inactive participants 2009-01-01 163

Measure	Date	Value
2023: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2023 401k membership
Total participants, beginning-of-year	2023-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	165
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	165
2022: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2022 401k membership
Total participants, beginning-of-year	2022-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	163
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	163
2021: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2021 401k membership
Total participants, beginning-of-year	2021-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	167
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	167
2020: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2020 401k membership
Total participants, beginning-of-year	2020-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	243
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	243
2019: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2019 401k membership
Total participants, beginning-of-year	2019-01-01	237
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	236
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	236
2018: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2018 401k membership
Total participants, beginning-of-year	2018-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	127
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	127
2017: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2017 401k membership
Total participants, beginning-of-year	2017-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	164
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	164
2016: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2016 401k membership
Total participants, beginning-of-year	2016-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	156
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	157
2015: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2015 401k membership
Total participants, beginning-of-year	2015-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	156
Total of all active and inactive participants	2015-01-01	156
2014: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2014 401k membership
Total participants, beginning-of-year	2014-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	156
Total of all active and inactive participants	2014-01-01	156
2013: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2013 401k membership
Total participants, beginning-of-year	2013-01-01	217
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	219
Total of all active and inactive participants	2013-01-01	219
2012: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2012 401k membership
Total participants, beginning-of-year	2012-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	217
Total of all active and inactive participants	2012-01-01	217
2011: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2011 401k membership
Total participants, beginning-of-year	2011-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	211
Total of all active and inactive participants	2011-01-01	211
2009: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2009 401k membership
Total participants, beginning-of-year	2009-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	163
Total of all active and inactive participants	2009-01-01	163

Form 5500 Responses for REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA

2023: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 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: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: REECE SUPPLY COMPANY OF DALLAS WELFARE BENEFIT PLA 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan 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

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	192
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $1,764
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00631462

Policy instance

Insurance contract or identification number	00631462
Number of Individuals Covered	165
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $25,048
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $310,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

935226

Policy instance

Insurance contract or identification number	935226
Number of Individuals Covered	76
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,584
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $64,546
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

10269181001

Policy instance

Insurance contract or identification number	10269181001
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $32
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	192
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $912
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	88
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $1,718
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	48
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $1,113
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,950
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

10269171001

Policy instance

Insurance contract or identification number	10269171001
Number of Individuals Covered	179
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $990
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00631462

Policy instance

Insurance contract or identification number	00631462
Number of Individuals Covered	163
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $304,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

935226

Policy instance

Insurance contract or identification number	935226
Number of Individuals Covered	82
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,757
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $58,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,563
Additional information about fees paid to insurance broker	BASE COMMISSION
Insurance broker organization code?	3

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	185
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $1,120
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,395
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	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	186
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $662
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	662
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

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	89
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $1,217
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1217
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

10269171001

Policy instance

Insurance contract or identification number	10269171001
Number of Individuals Covered	152
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $862
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $862

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

Policy contract number

10269171001

Policy instance

Insurance contract or identification number	10269171001
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	42
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $897
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	897
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

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	38
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $2,328
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1358
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

935226

Policy instance

Insurance contract or identification number	935226
Number of Individuals Covered	91
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,432
Total amount of fees paid to insurance company	USD $2,002
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $66,618
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
Amount paid for insurance broker fees	2002
Additional information about fees paid to insurance broker	BASE COMMISSION BONUS COMMISSION
Insurance broker organization code?	3

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	161
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $3,139
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1831
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

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	164
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $1,651
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	963
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

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	84
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $3,418
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1994
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

10269171001

Policy instance

Insurance contract or identification number	10269171001
Number of Individuals Covered	159
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,205
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,205

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00631462

Policy instance

Insurance contract or identification number	00631462
Number of Individuals Covered	167
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,621
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $272,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,621
Insurance broker organization code?	3

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	156
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	173
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

Policy instance

Number of Individuals Covered	91
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,810
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $12,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,737
Insurance broker organization code?	3

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

Policy contract number

10269171001

Policy instance

Insurance contract or identification number	10269171001
Number of Individuals Covered	183
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $753
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $753
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	243
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $42,726
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $431,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,500
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	173
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

Policy instance

Number of Individuals Covered	91
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,062
Other welfare benefits provided	CHILD CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,034
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

Policy instance

Number of Individuals Covered	91
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $132
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $49,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132
Insurance broker organization code?	3

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	98
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000BNZW

Policy instance

Insurance contract or identification number	G000BNZW
Number of Individuals Covered	48
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $18,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	156
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

903157

Policy instance

Insurance contract or identification number	903157
Number of Individuals Covered	192
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTIAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $77,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	124
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	119
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,467
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,467
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	236
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $45,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $488,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,000
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	55
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,806
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,806
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	35
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,055
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $9,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,055
Insurance broker organization code?	3

UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	27
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	22
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	89
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,133
Total amount of fees paid to insurance company	USD $422
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,768
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
Amount paid for insurance broker fees	422
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	237
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $45,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $386,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,000
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	109
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,108
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,108
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5487782

Policy instance

Insurance contract or identification number	5487782
Number of Individuals Covered	123
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

903157

Policy instance

Insurance contract or identification number	903157
Number of Individuals Covered	171
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTIAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $77,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	156
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	156
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,650
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

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	428
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of fees paid to insurance company	USD $69
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTIAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $89,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	69
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC.

SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 )

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	90
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	48
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of commissions paid to insurance broker	USD $2,323
Total amount of fees paid to insurance company	USD $973
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS INSURAN
Welfare Benefit Premiums Paid to Carrier	USD $20,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,323
Amount paid for insurance broker fees	973
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	245
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of commissions paid to insurance broker	USD $41,250
Total amount of fees paid to insurance company	USD $1,125
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $333,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,250
Amount paid for insurance broker fees	1125
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

C727

Policy instance

Insurance contract or identification number	C727
Number of Individuals Covered	156
Insurance policy start date	2017-04-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $2,434
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

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	495
Insurance policy start date	2017-04-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $99
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $89,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	99
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC.

SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 )

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	114
Insurance policy start date	2017-04-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	48
Insurance policy start date	2017-04-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,556
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS INSURAN
Welfare Benefit Premiums Paid to Carrier	USD $17,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,556
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037002

Policy instance

Insurance contract or identification number	037002
Number of Individuals Covered	226
Insurance policy start date	2017-04-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $33,750
Total amount of fees paid to insurance company	USD $973
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $327,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,750
Amount paid for insurance broker fees	973
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC.

SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 )

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	84
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	223
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,284
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $202,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1284
Additional information about fees paid to insurance broker	SPECIAL PROGRAMSSPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000000

Policy instance

Insurance contract or identification number	000000
Number of Individuals Covered	156
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	49
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $4,589
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS INSURAN
Welfare Benefit Premiums Paid to Carrier	USD $29,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,011
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

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

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	467
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $111,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

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

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	441
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $71
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $90,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 )

Policy contract number

KM05998717

Policy instance

Insurance contract or identification number	KM05998717
Number of Individuals Covered	66
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082

Policy instance

Insurance contract or identification number	037082
Number of Individuals Covered	198
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	49
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $3,241
Total amount of fees paid to insurance company	USD $1,579
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS INSURAN
Welfare Benefit Premiums Paid to Carrier	USD $31,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,241
Insurance broker organization code?	3
Amount paid for insurance broker fees	1579
Additional information about fees paid to insurance broker	PRODUCER BONUS AND NON-MONETARY COMPENSATION
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

INTERFACE EAP (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000000

Policy instance

Insurance contract or identification number	000000
Number of Individuals Covered	156
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE
Welfare Benefit Premiums Paid to Carrier	USD $3,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	45
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $2,058
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $17,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,343
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

GFZ37082

Policy instance

Insurance contract or identification number	GFZ37082
Number of Individuals Covered	143
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $12,521
Total amount of fees paid to insurance company	USD $115
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $83,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,329
Amount paid for insurance broker fees	86
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	JAMES H BRAWNER III

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4052713

Policy instance

Insurance contract or identification number	4052713
Number of Individuals Covered	60
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $2,091
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,380
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

UNION SECURITY DENTALCARE OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 52016 )

Policy contract number

5351004

Policy instance

Insurance contract or identification number	5351004
Number of Individuals Covered	8
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $91
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5351004

Policy instance

Insurance contract or identification number	5351004
Number of Individuals Covered	3
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $57
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5351004

Policy instance

Insurance contract or identification number	5351004
Number of Individuals Covered	43
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $2,362
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,297
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082 037513

Policy instance

Insurance contract or identification number	037082 037513
Number of Individuals Covered	219
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $24,849
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $765,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,735
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )

Policy contract number

535104

Policy instance

Insurance contract or identification number	535104
Number of Individuals Covered	28
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $672
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $397
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP INC

UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	32
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $727
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $666
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

UNION SECURITY DENTALCARE OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 52016 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	5
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	40
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $1,982
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,817
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 67802

Policy instance

Insurance contract or identification number	G# 67802
Number of Individuals Covered	0
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name	JAMES H BRAWNER III

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082 037513

Policy instance

Insurance contract or identification number	037082 037513
Number of Individuals Covered	217
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $40,992
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $817,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,992
Insurance broker organization code?	3
Insurance broker name	JAMES H BRAWNER III

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

GFZ37082

Policy instance

Insurance contract or identification number	GFZ37082
Number of Individuals Covered	151
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $11,686
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,700
Insurance broker organization code?	3
Insurance broker name	SUMMIT GLOBAL PARTNERS OF TX INC

UNION SECURITY DENTALCARE OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 52016 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	5
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	32
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $1,652
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082 037513

Policy instance

Insurance contract or identification number	037082 037513
Number of Individuals Covered	211
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $42,395
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $844,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 67802

Policy instance

Insurance contract or identification number	G# 67802
Number of Individuals Covered	138
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $10,386
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )

Policy contract number

G# 5351004

Policy instance

Insurance contract or identification number	G# 5351004
Number of Individuals Covered	29
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $692
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 67802

Policy instance

Insurance contract or identification number	G# 67802
Number of Individuals Covered	151
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $9,944
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,944
Insurance broker organization code?	3
Insurance broker name	JAMES H BRAWNER III

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

037082 037513

Policy instance

Insurance contract or identification number	037082 037513
Number of Individuals Covered	222
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $45,996
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $921,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,996
Insurance broker organization code?	3
Insurance broker name	JAMES H BRAWNER III

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Company Name:	REECE SUPPLY COMPANY, INC.
Employer identification number (EIN):	750783034
NAIC Classification:	423600

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1950-07-28
Company Identification Number:	0010395600
Legal Registered Office Address:	PO BOX 170269 IRVING United States of America (USA) 75017