401k Plan data: SIMMONS FOODS INC. GROUP MEDICAL PLAN plan

SIMMONS FOODS INC. GROUP MEDICAL PLAN 401k Plan overview

Plan Name	SIMMONS FOODS INC. GROUP MEDICAL PLAN
Plan identification number	503

SIMMONS FOODS INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

SIMMONS FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name: SIMMONS FOODS, INC.

Employer identification number (EIN): 750995574

NAIC Classification: 311610
NAIC Description: Animal Slaughtering and Processing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIMMONS FOODS INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01
503 2022-01-01
503 2021-01-01
503 2020-01-01
503 2019-01-01
503 2018-01-01
503 2017-01-01 CARMEN H. SEAL
503 2016-01-01 CARMEN H. SEAL
503 2015-01-01 CARMEN H. SEAL
503 2014-01-01 CARMEN H. SEAL
503 2013-01-01 CARMEN H. SEAL
503 2012-04-01 CARMEN H. SEAL
503 2011-04-01 MICHAEL JONES
503 2011-01-01 MICHAEL JONES
503 2010-04-01 MICHAEL JONES
503 2009-04-01 MICHAEL JONES
503 2008-04-01 MICHAEL JONES

Plan Statistics for SIMMONS FOODS INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for SIMMONS FOODS INC. GROUP MEDICAL PLAN

Measure Date Value
2022: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 6,956
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 7,689
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 7,689
2021: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 6,533
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 6,956
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 6,956
2020: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 5,981
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 6,533
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 6,533
2019: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 5,759
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 5,981
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 5,981
2018: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 5,140
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 5,759
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 5,759
2017: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 4,783
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 5,140
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 5,140
2016: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 4,494
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 4,765
Number of retired or separated participants receiving benefits 2016-01-01 18
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 4,783
2015: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4,872
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 4,475
Number of retired or separated participants receiving benefits 2015-01-01 19
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 4,494
2014: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4,707
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4,860
Number of retired or separated participants receiving benefits 2014-01-01 12
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 4,872
2013: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4,531
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 4,686
Number of retired or separated participants receiving benefits 2013-01-01 21
Total of all active and inactive participants 2013-01-01 4,707
2012: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 4,620
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 4,531
Number of retired or separated participants receiving benefits 2012-04-01 28
Total of all active and inactive participants 2012-04-01 4,559
2011: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 5,148
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 4,620
Number of retired or separated participants receiving benefits 2011-04-01 22
Total of all active and inactive participants 2011-04-01 4,642
Total participants 2011-04-01 4,642
Total participants, beginning-of-year 2011-01-01 5,148
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4,620
Number of retired or separated participants receiving benefits 2011-01-01 22
Total of all active and inactive participants 2011-01-01 4,642
Total participants 2011-01-01 4,642
2010: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-04-01 4,914
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 5,131
Number of retired or separated participants receiving benefits 2010-04-01 17
Total of all active and inactive participants 2010-04-01 5,148
Total participants 2010-04-01 5,148
2009: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-04-01 4,671
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 4,848
Number of retired or separated participants receiving benefits 2009-04-01 66
Total of all active and inactive participants 2009-04-01 4,914
Total participants 2009-04-01 4,914
2008: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2008 401k membership
Total participants, beginning-of-year 2008-04-01 3,932
Total number of active participants reported on line 7a of the Form 5500 2008-04-01 4,649
Number of retired or separated participants receiving benefits 2008-04-01 22
Total of all active and inactive participants 2008-04-01 4,671
Total participants 2008-04-01 4,671

Measure	Date	Value
2022: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	6,956
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	7,689
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	7,689
2021: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	6,533
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	6,956
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	6,956
2020: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	5,981
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	6,533
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	6,533
2019: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	5,759
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	5,981
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	5,981
2018: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5,140
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5,759
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	5,759
2017: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	4,783
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	5,140
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	5,140
2016: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	4,494
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	4,765
Number of retired or separated participants receiving benefits	2016-01-01	18
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	4,783
2015: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4,872
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	4,475
Number of retired or separated participants receiving benefits	2015-01-01	19
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	4,494
2014: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4,707
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4,860
Number of retired or separated participants receiving benefits	2014-01-01	12
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	4,872
2013: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4,531
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	4,686
Number of retired or separated participants receiving benefits	2013-01-01	21
Total of all active and inactive participants	2013-01-01	4,707
2012: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	4,620
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	4,531
Number of retired or separated participants receiving benefits	2012-04-01	28
Total of all active and inactive participants	2012-04-01	4,559
2011: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	5,148
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	4,620
Number of retired or separated participants receiving benefits	2011-04-01	22
Total of all active and inactive participants	2011-04-01	4,642
Total participants	2011-04-01	4,642
Total participants, beginning-of-year	2011-01-01	5,148
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,620
Number of retired or separated participants receiving benefits	2011-01-01	22
Total of all active and inactive participants	2011-01-01	4,642
Total participants	2011-01-01	4,642
2010: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-04-01	4,914
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	5,131
Number of retired or separated participants receiving benefits	2010-04-01	17
Total of all active and inactive participants	2010-04-01	5,148
Total participants	2010-04-01	5,148
2009: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-04-01	4,671
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	4,848
Number of retired or separated participants receiving benefits	2009-04-01	66
Total of all active and inactive participants	2009-04-01	4,914
Total participants	2009-04-01	4,914
2008: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2008 401k membership
Total participants, beginning-of-year	2008-04-01	3,932
Total number of active participants reported on line 7a of the Form 5500	2008-04-01	4,649
Number of retired or separated participants receiving benefits	2008-04-01	22
Total of all active and inactive participants	2008-04-01	4,671
Total participants	2008-04-01	4,671

Form 5500 Responses for SIMMONS FOODS INC. GROUP MEDICAL PLAN

2022: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL 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: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Submission has been amended	Yes
2012-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	First time form 5500 has been submitted	Yes
2011-04-01	Submission has been amended	Yes
2011-04-01	This submission is the final filing	No
2011-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-04-01	Plan is a collectively bargained plan	No
2011-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
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
2010: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	First time form 5500 has been submitted	Yes
2010-04-01	Submission has been amended	No
2010-04-01	This submission is the final filing	No
2010-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-04-01	Plan is a collectively bargained plan	No
2010-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	First time form 5500 has been submitted	Yes
2009-04-01	Submission has been amended	No
2009-04-01	This submission is the final filing	No
2009-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-04-01	Plan is a collectively bargained plan	No
2009-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: SIMMONS FOODS INC. GROUP MEDICAL PLAN 2008 form 5500 responses
2008-04-01	Type of plan entity	Single employer plan
2008-04-01	First time form 5500 has been submitted	Yes
2008-04-01	Submission has been amended	No
2008-04-01	This submission is the final filing	No
2008-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-04-01	Plan is a collectively bargained plan	No
2008-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-04-01	Plan benefit arrangement – Insurance	Yes
2008-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	11272
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	9
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $84
Other welfare benefits provided	CRITIAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70611-6

Policy instance

Insurance contract or identification number	70611-6
Number of Individuals Covered	6178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $543,230
Total amount of fees paid to insurance company	USD $33,569
Other welfare benefits provided	VOLUNTARY CI, ACCIDENT, AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $1,696,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $305,130
Insurance broker organization code?	3
Amount paid for insurance broker fees	20891
Additional information about fees paid to insurance broker	SERVICE FEE

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

Policy contract number

030358

Policy instance

Insurance contract or identification number	030358
Number of Individuals Covered	5345
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $23,912
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $483,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,912
Insurance broker organization code?	3

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	7689
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $39,224
Total amount of fees paid to insurance company	USD $20,645
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,127,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,612
Amount paid for insurance broker fees	16723
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	4493
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $301,264
Total amount of fees paid to insurance company	USD $60,252
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,315,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $150,632
Amount paid for insurance broker fees	30126
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	3508
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $185,174
Total amount of fees paid to insurance company	USD $24,690
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,326,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92,587
Amount paid for insurance broker fees	12345
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	886
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $86,145
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $483,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,073
Insurance broker organization code?	3

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

10620-01

Policy instance

Insurance contract or identification number	10620-01
Number of Individuals Covered	83461
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $70,684
Welfare Benefit Premiums Paid to Carrier	USD $1,413,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,684
Insurance broker organization code?	3

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	13
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $122
Other welfare benefits provided	CRITIAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	10231
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

030358

Policy instance

Insurance contract or identification number	030358
Number of Individuals Covered	4559
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $21,652
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $433,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,652
Insurance broker organization code?	3

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	6956
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $36,486
Total amount of fees paid to insurance company	USD $18,782
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $939,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,243
Amount paid for insurance broker fees	15133
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	2811
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $162,170
Total amount of fees paid to insurance company	USD $21,622
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,081,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,085
Amount paid for insurance broker fees	10811
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	1124
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $192,754
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $562,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $96,377
Insurance broker organization code?	3

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

10620-00

Policy instance

Insurance contract or identification number	10620-00
Number of Individuals Covered	11886
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $42,153
Welfare Benefit Premiums Paid to Carrier	USD $843,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,153
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70611-6

Policy instance

Insurance contract or identification number	70611-6
Number of Individuals Covered	6567
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $486,759
Total amount of fees paid to insurance company	USD $35,600
Other welfare benefits provided	VOLUNTARY CI, ACCIDENT, AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $1,468,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $272,202
Insurance broker organization code?	3
Amount paid for insurance broker fees	35600
Additional information about fees paid to insurance broker	SERVICE FEE TECHNOLOGY FEE

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP0009145010-B

Policy instance

Insurance contract or identification number	GTP0009145010-B
Number of Individuals Covered	7430
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,752
Other welfare benefits provided	BTA
Welfare Benefit Premiums Paid to Carrier	USD $31,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,752
Insurance broker organization code?	3

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	3700
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $257,992
Total amount of fees paid to insurance company	USD $51,598
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,579,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,996
Amount paid for insurance broker fees	25799
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	1106
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $214,070
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $493,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108,221
Insurance broker organization code?	3

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	4271
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $20,711
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $415,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,711
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	9727
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,394
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,394
Insurance broker organization code?	3

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	2492
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,986
Total amount of fees paid to insurance company	USD $1,444
Other welfare benefits provided	CRITIAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $6,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,986
Amount paid for insurance broker fees	722
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	6533
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $33,420
Total amount of fees paid to insurance company	USD $17,204
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $860,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,710
Amount paid for insurance broker fees	13862
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	3503
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $215,794
Total amount of fees paid to insurance company	USD $43,158
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,157,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,897
Amount paid for insurance broker fees	21579
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	2526
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $144,022
Total amount of fees paid to insurance company	USD $19,204
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $960,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,011
Amount paid for insurance broker fees	9602
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

405146

Policy instance

Insurance contract or identification number	405146
Number of Individuals Covered	6176
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Welfare Benefit Premiums Paid to Carrier	USD $849,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70611-6

Policy instance

Insurance contract or identification number	70611-6
Number of Individuals Covered	4422
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $559,612
Total amount of fees paid to insurance company	USD $46,782
Other welfare benefits provided	VOLUNTARY CI, ACCIDENT, AND HCI
Welfare Benefit Premiums Paid to Carrier	USD $1,254,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $279,806
Amount paid for insurance broker fees	46782
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	3517
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $113,976
Total amount of fees paid to insurance company	USD $17,135
Other welfare benefits provided	CRITIAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $439,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,981
Amount paid for insurance broker fees	8574
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	9060
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $16,395
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,395
Insurance broker organization code?	3

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	3853
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $20,959
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $419,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,959
Insurance broker organization code?	3

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5981
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $38,332
Total amount of fees paid to insurance company	USD $19,242
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $962,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,166
Amount paid for insurance broker fees	15409
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	3359
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $212,956
Total amount of fees paid to insurance company	USD $42,592
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,129,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $106,478
Amount paid for insurance broker fees	21296
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	2187
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $147,454
Total amount of fees paid to insurance company	USD $19,660
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $983,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,727
Amount paid for insurance broker fees	9830
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	1021
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $126,254
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $434,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,001
Insurance broker organization code?	3

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

Policy contract number

405146

Policy instance

Insurance contract or identification number	405146
Number of Individuals Covered	6769
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $876,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70611-6

Policy instance

Insurance contract or identification number	70611-6
Number of Individuals Covered	2075
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $369,221
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS/HCI
Welfare Benefit Premiums Paid to Carrier	USD $547,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $194,341
Insurance broker organization code?	3

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	3167
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $165,806
Total amount of fees paid to insurance company	USD $33,162
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,658,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,903
Amount paid for insurance broker fees	16581
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5759
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $30,194
Total amount of fees paid to insurance company	USD $15,682
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $784,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,097
Amount paid for insurance broker fees	12663
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	7637
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,356
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $327,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,356
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	8684
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $15,056
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,056
Insurance broker organization code?	3

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	2722
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $81,722
Total amount of fees paid to insurance company	USD $10,587
Other welfare benefits provided	CRITIAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $314,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,854
Amount paid for insurance broker fees	5421
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	826
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $129,684
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $371,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,842
Insurance broker organization code?	3

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1980
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $120,698
Total amount of fees paid to insurance company	USD $16,094
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $804,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,349
Amount paid for insurance broker fees	8047
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

405146

Policy instance

Insurance contract or identification number	405146
Number of Individuals Covered	5482
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Welfare Benefit Premiums Paid to Carrier	USD $666,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

896960

Policy instance

Insurance contract or identification number	896960
Number of Individuals Covered	1171
Insurance policy start date	2018-01-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $37,426
Total amount of fees paid to insurance company	USD $9,154
Other welfare benefits provided	SUPPLEMENTAL CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $161,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,357
Amount paid for insurance broker fees	4680
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009145010

Policy instance

Insurance contract or identification number	GTP 0009145010
Number of Individuals Covered	6770
Insurance policy start date	2017-08-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $1,018
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $4,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $611
Insurance broker organization code?	3

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP0009145010-A

Policy instance

Insurance contract or identification number	GTP0009145010-A
Number of Individuals Covered	6770
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,863
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $39,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,918
Insurance broker organization code?	3

CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 )

Policy contract number

896960

Policy instance

Insurance contract or identification number	896960
Number of Individuals Covered	2
Insurance policy start date	2018-07-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $21,567
Other welfare benefits provided	CRITICAL ILLNESS/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $154,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,212
Insurance broker organization code?	3

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	6543
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16,632
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $310,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,632
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5140
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $25,772
Total amount of fees paid to insurance company	USD $14,017
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $700,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,886
Amount paid for insurance broker fees	11440
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BCINSOURCING

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	2694
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $145,732
Total amount of fees paid to insurance company	USD $29,146
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,457,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,866
Amount paid for insurance broker fees	14573
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BCINSOURCING, LLC

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1819
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $122,406
Total amount of fees paid to insurance company	USD $16,322
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $816,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,203
Amount paid for insurance broker fees	8161
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BCINSOURCING, LLC

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	781
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $131,810
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DISABILITY AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $306,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,905
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC.

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

Policy contract number

405146 0010

Policy instance

Insurance contract or identification number	405146 0010
Number of Individuals Covered	4079
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Welfare Benefit Premiums Paid to Carrier	USD $484,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

896960

Policy instance

Insurance contract or identification number	896960
Number of Individuals Covered	1207
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $93,570
Total amount of fees paid to insurance company	USD $11,082
Other welfare benefits provided	SUPPLEMENTAL CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $348,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,209
Amount paid for insurance broker fees	5541
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	MACK, BENJAMIN

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000009550

Policy instance

Insurance contract or identification number	000009550
Number of Individuals Covered	7542
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,532
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,532
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

0008224763

Policy instance

Insurance contract or identification number	0008224763
Number of Individuals Covered	2384
Insurance policy start date	2017-01-01
Insurance policy end date	2018-01-01
Total amount of commissions paid to insurance broker	USD $68,138
Total amount of fees paid to insurance company	USD $8,438
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $310,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,947
Amount paid for insurance broker fees	4577
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RICHARD J CAZZELL

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009145010

Policy instance

Insurance contract or identification number	GTP 0009145010
Number of Individuals Covered	5624
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $7,267
Other welfare benefits provided	AD&D AND PARALYSIS BENEFITS
Welfare Benefit Premiums Paid to Carrier	USD $29,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,360
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

405146 0020

Policy instance

Insurance contract or identification number	405146 0020
Number of Individuals Covered	671
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Welfare Benefit Premiums Paid to Carrier	USD $77,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

405146 0010

Policy instance

Insurance contract or identification number	405146 0010
Number of Individuals Covered	3735
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Welfare Benefit Premiums Paid to Carrier	USD $352,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	594
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $53,338
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DISABILITY AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $136,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,669
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC.

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1695
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $114,138
Total amount of fees paid to insurance company	USD $15,220
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $751,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,069
Amount paid for insurance broker fees	7610
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	2243
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $98,046
Total amount of fees paid to insurance company	USD $19,610
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $974,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,023
Amount paid for insurance broker fees	9805
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	4719
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,378
Total amount of fees paid to insurance company	USD $9,878
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $489,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,189
Amount paid for insurance broker fees	8040
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51125

Policy instance

Insurance contract or identification number	51125
Number of Individuals Covered	182
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,264
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $54,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,264
Insurance broker organization code?	3
Insurance broker name	TFC INSURANCE AGENCY

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51110

Policy instance

Insurance contract or identification number	51110
Number of Individuals Covered	61
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,083
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $17,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,083
Insurance broker organization code?	3
Insurance broker name	THE FARMINGTON COMPANY

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	5587
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,237
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $270,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,237
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

9550

Policy instance

Insurance contract or identification number	9550
Number of Individuals Covered	6767
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,969
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,969
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

896960

Policy instance

Insurance contract or identification number	896960
Number of Individuals Covered	1394
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $32,811
Total amount of fees paid to insurance company	USD $463
Other welfare benefits provided	SUPPLEMENTAL CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $202,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,474
Amount paid for insurance broker fees	361
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	1915
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $54,435
Total amount of fees paid to insurance company	USD $6,956
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $276,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $497
Insurance broker organization code?	3
Amount paid for insurance broker fees	3478
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	1853
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $67,764
Total amount of fees paid to insurance company	USD $12,307
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $258,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $542
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5277
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,286
Total amount of fees paid to insurance company	USD $6,920
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $327,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,143
Amount paid for insurance broker fees	5091
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	2553
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $83,528
Total amount of fees paid to insurance company	USD $16,706
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $794,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,764
Amount paid for insurance broker fees	8353
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1787
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $94,010
Total amount of fees paid to insurance company	USD $12,536
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $572,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,005
Amount paid for insurance broker fees	6268
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51370

Policy instance

Insurance contract or identification number	51370
Number of Individuals Covered	269
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $82,466
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DISABILITY AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $134,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,233
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51110

Policy instance

Insurance contract or identification number	51110
Number of Individuals Covered	71
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,820
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $25,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,820
Insurance broker organization code?	3
Insurance broker name	THE FARMINGTON COMPANY

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51125

Policy instance

Insurance contract or identification number	51125
Number of Individuals Covered	202
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,366
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $77,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,366
Insurance broker organization code?	3
Insurance broker name	TFC INSURANCE AGENCY

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	5064
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $13,005
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $261,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,005
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	47
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,013
Total amount of fees paid to insurance company	USD $288
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55
Insurance broker organization code?	3
Amount paid for insurance broker fees	144
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

9550

Policy instance

Insurance contract or identification number	9550
Number of Individuals Covered	6828
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,418
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,418
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51125

Policy instance

Insurance contract or identification number	51125
Number of Individuals Covered	256
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $40,787
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $155,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,787
Insurance broker organization code?	3
Insurance broker name	TFC INSURANCE AGENCY

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1636
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $89,355
Total amount of fees paid to insurance company	USD $11,642
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,043,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,537
Amount paid for insurance broker fees	5724
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	2018
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $72,655
Total amount of fees paid to insurance company	USD $14,148
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $840,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,795
Amount paid for insurance broker fees	6959
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RICHARD J. CAZZELL

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5332
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,798
Total amount of fees paid to insurance company	USD $5,870
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $330,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,673
Amount paid for insurance broker fees	3957
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RICHARD J. CAZZELL

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51129

Policy instance

Insurance contract or identification number	51129
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,077
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,077
Insurance broker organization code?	3
Insurance broker name	TFC INSURANCE AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

9550

Policy instance

Insurance contract or identification number	9550
Number of Individuals Covered	6328
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,668
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,668
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	62
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,174
Total amount of fees paid to insurance company	USD $315
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1
Insurance broker organization code?	3
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	5192
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,838
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $265,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,838
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51128

Policy instance

Insurance contract or identification number	51128
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $690
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $690
Insurance broker organization code?	3
Insurance broker name	THE FARMINGTON COMPANY

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

51110

Policy instance

Insurance contract or identification number	51110
Number of Individuals Covered	86
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $24,052
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, DISABILITY AND AD
Welfare Benefit Premiums Paid to Carrier	USD $93,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,052
Insurance broker organization code?	3
Insurance broker name	THE FARMINGTON COMPANY

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	2033
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $153,868
Total amount of fees paid to insurance company	USD $25,079
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $227,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,294
Amount paid for insurance broker fees	97
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5098
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,826
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $153,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,274
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS, INC.

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	2382
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $55,763
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $376,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,716
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS, INC.

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1873
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $59,122
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $11,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,647
Insurance broker organization code?	3
Insurance broker name	HEALTH & BENEFIT SYSTEMS INC

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

Policy contract number

30358

Policy instance

Insurance contract or identification number	30358
Number of Individuals Covered	5072
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,321
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,835
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

9550

Policy instance

Insurance contract or identification number	9550
Number of Individuals Covered	7003
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $12,325
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,972
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	69
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,985
Total amount of fees paid to insurance company	USD $508
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $136
Insurance broker organization code?	3
Amount paid for insurance broker fees	229
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker name	TFC INSURANCE AGENCY, INC.

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

Policy contract number

R0071308

Policy instance

Insurance contract or identification number	R0071308
Number of Individuals Covered	1058
Insurance policy start date	2012-04-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,802
Total amount of fees paid to insurance company	USD $136
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,802
Amount paid for insurance broker fees	136
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RICHARD J CAZZELL

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	884
Insurance policy start date	2010-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $70,458
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

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	123
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $7,061
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $62,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

60338

Policy instance

Insurance contract or identification number	60338
Number of Individuals Covered	288
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,941
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	884
Insurance policy start date	2010-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $70,458
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

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5328
Insurance policy start date	2010-06-01
Insurance policy end date	2011-06-01
Total amount of commissions paid to insurance broker	USD $15,708
Life 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

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1270
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $58,053
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

60338

Policy instance

Insurance contract or identification number	60338
Number of Individuals Covered	288
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,941
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5328
Insurance policy start date	2010-06-01
Insurance policy end date	2011-06-01
Total amount of commissions paid to insurance broker	USD $15,708
Life 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

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1270
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $58,053
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	123
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $7,061
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $62,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

60338

Policy instance

Insurance contract or identification number	60338
Number of Individuals Covered	340
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,990
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

517971

Policy instance

Insurance contract or identification number	517971
Number of Individuals Covered	5100
Insurance policy start date	2009-06-01
Insurance policy end date	2010-06-01
Total amount of commissions paid to insurance broker	USD $15,265
Life 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

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

Policy contract number

111061

Policy instance

Insurance contract or identification number	111061
Number of Individuals Covered	1332
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $58,710
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

8224763

Policy instance

Insurance contract or identification number	8224763
Number of Individuals Covered	147
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $18,497
Welfare Benefit Premiums Paid to Carrier	USD $71,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

111695

Policy instance

Insurance contract or identification number	111695
Number of Individuals Covered	965
Insurance policy start date	2009-10-01
Insurance policy end date	2010-10-01
Total amount of commissions paid to insurance broker	USD $67,134
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

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Company Name:	SIMMONS FOODS, INC.
Employer identification number (EIN):	750995574
NAIC Classification:	311610
NAIC Description:	Animal Slaughtering and Processing