401k Plan data: ARIZONA MATERIALS LLC plan

ARIZONA MATERIALS LLC 401k Plan overview

Plan Name	ARIZONA MATERIALS LLC
Plan identification number	501

ARIZONA MATERIALS LLC 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

ARIZONA MATERIALS, LLC has sponsored the creation of one or more 401k plans.

Company Name: ARIZONA MATERIALS, LLC

Employer identification number (EIN): 753107006

NAIC Classification: 327300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARIZONA MATERIALS LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01
501 2021-02-01
501 2020-02-01
501 2019-02-01
501 2018-02-01
501 2017-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2018-08-16
501 2016-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2017-07-19
501 2015-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2016-06-16
501 2014-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2015-06-09
501 2013-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2014-07-22
501 2012-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2013-05-20
501 2011-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2012-07-27
501 2009-02-01 KAREN JOHNSON PATRICK MCLAUGHLIN 2010-11-04

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-02-01
501	2021-02-01
501	2020-02-01
501	2019-02-01
501	2018-02-01
501	2017-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2018-08-16
501	2016-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2017-07-19
501	2015-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2016-06-16
501	2014-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2015-06-09
501	2013-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2014-07-22
501	2012-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2013-05-20
501	2011-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2012-07-27
501	2009-02-01	KAREN JOHNSON	PATRICK MCLAUGHLIN	2010-11-04

Plan Statistics for ARIZONA MATERIALS LLC

401k plan membership statisitcs for ARIZONA MATERIALS LLC

Measure Date Value
2022: ARIZONA MATERIALS LLC 2022 401k membership
Total participants, beginning-of-year 2022-02-01 306
Total number of active participants reported on line 7a of the Form 5500 2022-02-01 306
Total of all active and inactive participants 2022-02-01 306
Total participants 2022-02-01 306
2021: ARIZONA MATERIALS LLC 2021 401k membership
Total participants, beginning-of-year 2021-02-01 305
Total number of active participants reported on line 7a of the Form 5500 2021-02-01 306
Total of all active and inactive participants 2021-02-01 306
Total participants 2021-02-01 306
2020: ARIZONA MATERIALS LLC 2020 401k membership
Total participants, beginning-of-year 2020-02-01 319
Total number of active participants reported on line 7a of the Form 5500 2020-02-01 305
Total of all active and inactive participants 2020-02-01 305
Total participants 2020-02-01 305
2019: ARIZONA MATERIALS LLC 2019 401k membership
Total participants, beginning-of-year 2019-02-01 270
Total number of active participants reported on line 7a of the Form 5500 2019-02-01 305
Total of all active and inactive participants 2019-02-01 305
Total participants 2019-02-01 305
Number of participants with account balances 2019-02-01 0
2018: ARIZONA MATERIALS LLC 2018 401k membership
Total participants, beginning-of-year 2018-02-01 247
Total number of active participants reported on line 7a of the Form 5500 2018-02-01 270
Total of all active and inactive participants 2018-02-01 270
Total participants 2018-02-01 270
2017: ARIZONA MATERIALS LLC 2017 401k membership
Total participants, beginning-of-year 2017-02-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 247
Total of all active and inactive participants 2017-02-01 247
Total participants 2017-02-01 247
2016: ARIZONA MATERIALS LLC 2016 401k membership
Total participants, beginning-of-year 2016-02-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 247
Total of all active and inactive participants 2016-02-01 247
Total participants 2016-02-01 247
2015: ARIZONA MATERIALS LLC 2015 401k membership
Total participants, beginning-of-year 2015-02-01 233
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 240
Total of all active and inactive participants 2015-02-01 240
Total participants 2015-02-01 0
2014: ARIZONA MATERIALS LLC 2014 401k membership
Total participants, beginning-of-year 2014-02-01 230
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 233
Total of all active and inactive participants 2014-02-01 233
Total participants 2014-02-01 0
2013: ARIZONA MATERIALS LLC 2013 401k membership
Total participants, beginning-of-year 2013-02-01 196
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 230
Total of all active and inactive participants 2013-02-01 230
Total participants 2013-02-01 0
2012: ARIZONA MATERIALS LLC 2012 401k membership
Total participants, beginning-of-year 2012-02-01 153
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 196
Total of all active and inactive participants 2012-02-01 196
Total participants 2012-02-01 0
2011: ARIZONA MATERIALS LLC 2011 401k membership
Total participants, beginning-of-year 2011-02-01 110
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 153
Total of all active and inactive participants 2011-02-01 153
Total participants 2011-02-01 153
2009: ARIZONA MATERIALS LLC 2009 401k membership
Total participants, beginning-of-year 2009-02-01 210
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 116
Total of all active and inactive participants 2009-02-01 116
Total participants 2009-02-01 116

Measure	Date	Value
2022: ARIZONA MATERIALS LLC 2022 401k membership
Total participants, beginning-of-year	2022-02-01	306
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	306
Total of all active and inactive participants	2022-02-01	306
Total participants	2022-02-01	306
2021: ARIZONA MATERIALS LLC 2021 401k membership
Total participants, beginning-of-year	2021-02-01	305
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	306
Total of all active and inactive participants	2021-02-01	306
Total participants	2021-02-01	306
2020: ARIZONA MATERIALS LLC 2020 401k membership
Total participants, beginning-of-year	2020-02-01	319
Total number of active participants reported on line 7a of the Form 5500	2020-02-01	305
Total of all active and inactive participants	2020-02-01	305
Total participants	2020-02-01	305
2019: ARIZONA MATERIALS LLC 2019 401k membership
Total participants, beginning-of-year	2019-02-01	270
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	305
Total of all active and inactive participants	2019-02-01	305
Total participants	2019-02-01	305
Number of participants with account balances	2019-02-01	0
2018: ARIZONA MATERIALS LLC 2018 401k membership
Total participants, beginning-of-year	2018-02-01	247
Total number of active participants reported on line 7a of the Form 5500	2018-02-01	270
Total of all active and inactive participants	2018-02-01	270
Total participants	2018-02-01	270
2017: ARIZONA MATERIALS LLC 2017 401k membership
Total participants, beginning-of-year	2017-02-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	247
Total of all active and inactive participants	2017-02-01	247
Total participants	2017-02-01	247
2016: ARIZONA MATERIALS LLC 2016 401k membership
Total participants, beginning-of-year	2016-02-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	247
Total of all active and inactive participants	2016-02-01	247
Total participants	2016-02-01	247
2015: ARIZONA MATERIALS LLC 2015 401k membership
Total participants, beginning-of-year	2015-02-01	233
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	240
Total of all active and inactive participants	2015-02-01	240
Total participants	2015-02-01	0
2014: ARIZONA MATERIALS LLC 2014 401k membership
Total participants, beginning-of-year	2014-02-01	230
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	233
Total of all active and inactive participants	2014-02-01	233
Total participants	2014-02-01	0
2013: ARIZONA MATERIALS LLC 2013 401k membership
Total participants, beginning-of-year	2013-02-01	196
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	230
Total of all active and inactive participants	2013-02-01	230
Total participants	2013-02-01	0
2012: ARIZONA MATERIALS LLC 2012 401k membership
Total participants, beginning-of-year	2012-02-01	153
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	196
Total of all active and inactive participants	2012-02-01	196
Total participants	2012-02-01	0
2011: ARIZONA MATERIALS LLC 2011 401k membership
Total participants, beginning-of-year	2011-02-01	110
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	153
Total of all active and inactive participants	2011-02-01	153
Total participants	2011-02-01	153
2009: ARIZONA MATERIALS LLC 2009 401k membership
Total participants, beginning-of-year	2009-02-01	210
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	116
Total of all active and inactive participants	2009-02-01	116
Total participants	2009-02-01	116

Form 5500 Responses for ARIZONA MATERIALS LLC

2022: ARIZONA MATERIALS LLC 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: ARIZONA MATERIALS LLC 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ARIZONA MATERIALS LLC 2020 form 5500 responses
2020-02-01	Type of plan entity	Single employer plan
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ARIZONA MATERIALS LLC 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ARIZONA MATERIALS LLC 2018 form 5500 responses
2018-02-01	Type of plan entity	Single employer plan
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ARIZONA MATERIALS LLC 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: ARIZONA MATERIALS LLC 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: ARIZONA MATERIALS LLC 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ARIZONA MATERIALS LLC 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ARIZONA MATERIALS LLC 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ARIZONA MATERIALS LLC 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: ARIZONA MATERIALS LLC 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: ARIZONA MATERIALS LLC 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $33,951
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $226,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,951
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	306
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $4,881
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,881
Additional information about fees paid to insurance broker	LONG-TERM DISABILITY
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

038959

Policy instance

Insurance contract or identification number	038959
Number of Individuals Covered	641
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $70,920
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $652,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,920
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

5943140

Policy instance

Insurance contract or identification number	5943140
Number of Individuals Covered	986
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $17,290
Total amount of fees paid to insurance company	USD $255
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $343,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,290
Amount paid for insurance broker fees	255
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	202
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $32,715
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $218,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,715
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3

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

Policy contract number

5943140

Policy instance

Insurance contract or identification number	5943140
Number of Individuals Covered	953
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $16,705
Total amount of fees paid to insurance company	USD $4,733
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $317,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,705
Amount paid for insurance broker fees	4733
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	306
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $4,881
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,881
Additional information about fees paid to insurance broker	LONG-TERM DISABILITY
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

038959

Policy instance

Insurance contract or identification number	038959
Number of Individuals Covered	606
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $70,360
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $562,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,360
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	218
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $7,159
Other welfare benefits provided	CONTRACT ADMINISTRATION
Welfare Benefit Premiums Paid to Carrier	USD $2,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7159
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

038959

Policy instance

Insurance contract or identification number	038959
Number of Individuals Covered	305
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $6,086
Total amount of fees paid to insurance company	USD $66,900
Welfare Benefit Premiums Paid to Carrier	USD $507,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	66900
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $6,086

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	317
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-28
Total amount of commissions paid to insurance broker	USD $4,806
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,806
Additional information about fees paid to insurance broker	LONG-TERM DISABILITY
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	192
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-28
Total amount of commissions paid to insurance broker	USD $29,733
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,733
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	218
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

5943140

Policy instance

Insurance contract or identification number	5943140
Number of Individuals Covered	996
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,789
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $329,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,789
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	300
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $2,464
Total amount of fees paid to insurance company	USD $78,464
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	78463
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $2,464

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	305
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	280
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $4,683
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,683
Additional information about fees paid to insurance broker	LONG-TERM DISABILITY
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	180
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $27,296
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,296
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	300
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $64,180
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,180
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

KM05943140

Policy instance

Insurance contract or identification number	KM05943140
Number of Individuals Covered	305
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $2,465
Total amount of fees paid to insurance company	USD $1
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,465
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

KM05943140

Policy instance

Insurance contract or identification number	KM05943140
Number of Individuals Covered	270
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $2,441
Total amount of fees paid to insurance company	USD $1,313
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,441
Amount paid for insurance broker fees	1313
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	261
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of fees paid to insurance company	USD $40,479
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	40479
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	164
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $24,145
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,145
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	257
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $4,638
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,638
Additional information about fees paid to insurance broker	LONG-TERM DISABILITY
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	261
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	261
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of fees paid to insurance company	USD $91,303
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	70385
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5

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

Policy contract number

KM05943140

Policy instance

Insurance contract or identification number	KM05943140
Number of Individuals Covered	247
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	247
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of fees paid to insurance company	USD $19,492
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	19492
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3
Insurance broker name	ARIZONA BENEFITS CONSULTANTS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	167
Insurance policy start date	2016-03-01
Insurance policy end date	2017-02-28
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	254
Insurance policy start date	2016-03-01
Insurance policy end date	2017-02-28
Total amount of commissions paid to insurance broker	USD $29,444
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,826
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3
Insurance broker name	POWERS LEAVITT INSURANCE

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	247
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	247
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of fees paid to insurance company	USD $38,428
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	38428
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3
Insurance broker name	DENNY MOLLIHAN INC.

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	240
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of fees paid to insurance company	USD $118,879
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	61982
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	DENNY MOLLIHAN INC.

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	240
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	240
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	243
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $28,215
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,273
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3
Insurance broker name	POWERS LEAVITT INSURANCE

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115476

Policy instance

Insurance contract or identification number	10115476
Number of Individuals Covered	161
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	233
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	233
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of fees paid to insurance company	USD $121,137
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	63016
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	DENNY MOLLIHAN INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	246
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $20,539
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,556
Additional information about fees paid to insurance broker	SHORT-TERM DISABILITY
Insurance broker organization code?	3
Insurance broker name	POWERS LEAVITT INSURANCE

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	233
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	230
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	230
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of fees paid to insurance company	USD $103,762
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	57210
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	DENNY MOLLIHAN INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	215
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of fees paid to insurance company	USD $3,815
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
Amount paid for insurance broker fees	3815
Insurance broker organization code?	3
Insurance broker name	POWERS LEAVITT INSURANCE

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	230
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	196
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $34,154
Total amount of fees paid to insurance company	USD $42,820
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,154
Insurance broker organization code?	3
Amount paid for insurance broker fees	42820
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker name	GILSBAR, INC.

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	196
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	196
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	160
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $3,075
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,075
Insurance broker organization code?	3
Insurance broker name	POWERS LEAVITT INSURANCE

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	153
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $26,144
Total amount of fees paid to insurance company	USD $31,659
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	153
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Other welfare benefits provided	CONTRACT ADMINISTRATION
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

S5011

Policy instance

Insurance contract or identification number	S5011
Number of Individuals Covered	153
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10115475

Policy instance

Insurance contract or identification number	10115475
Number of Individuals Covered	115
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $2,761
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:	ARIZONA MATERIALS, LLC
Employer identification number (EIN):	753107006
NAIC Classification:	327300