401k Plan data: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN plan

KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 401k Plan overview

Plan Name	KNIGHT TRANSPORTATION, INC CAFETERIA PLAN
Plan identification number	501

KNIGHT TRANSPORTATION, INC CAFETERIA 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) Other welfare benefit cover

401k Sponsoring company profile

KNIGHT TRANSPORTATION, INC has sponsored the creation of one or more 401k plans.

Company Name: KNIGHT TRANSPORTATION, INC

Employer identification number (EIN): 860649974

NAIC Classification: 484120
NAIC Description: General Freight Trucking, Long-Distance

Additional information about KNIGHT TRANSPORTATION, INC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1993-06-14

Company Identification Number: 1734405

Legal Registered Office Address: 2290 STATE ROUTE 48
Oswego
FULTON
United States of America (USA)
13069

More information about KNIGHT TRANSPORTATION, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KNIGHT TRANSPORTATION, INC CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 TODD CANTRILL
501 2016-01-01 TODD CANTRILL
501 2015-01-01 MIKE MCGHEE
501 2014-01-01 TIFFANY LAGER
501 2013-01-01 TIFFANY LAGER
501 2012-01-01 DUSTIN ERICKSON
501 2011-01-01 VICKIE WILLIAMS
501 2010-01-01 STEVE COLLINS
501 2009-01-01 JASON JONES

Plan Statistics for KNIGHT TRANSPORTATION, INC CAFETERIA PLAN

401k plan membership statisitcs for KNIGHT TRANSPORTATION, INC CAFETERIA PLAN

Measure Date Value
2023: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 4,360
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 3,928
Total of all active and inactive participants 2023-01-01 3,928
Total participants 2023-01-01 3,928
2022: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 4,360
Total of all active and inactive participants 2022-01-01 4,360
Total participants 2022-01-01 4,360
2021: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 4,886
Total of all active and inactive participants 2021-01-01 4,886
Total participants 2021-01-01 4,886
2020: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 4,886
Total of all active and inactive participants 2020-01-01 4,886
Total participants 2020-01-01 4,886
2019: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 4,886
Total of all active and inactive participants 2019-01-01 4,886
Total participants 2019-01-01 4,886
Number of participants with account balances 2019-01-01 0
2018: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 4,886
Total of all active and inactive participants 2018-01-01 4,886
Total participants 2018-01-01 4,886
2017: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 4,886
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 4,886
Total of all active and inactive participants 2017-01-01 4,886
Total participants 2017-01-01 4,886
2016: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 4,886
Total of all active and inactive participants 2016-01-01 4,886
Total participants 2016-01-01 4,886
2015: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 4,026
Total of all active and inactive participants 2015-01-01 4,026
Total participants 2015-01-01 0
2014: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,910
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3,299
Total of all active and inactive participants 2014-01-01 3,299
Total participants 2014-01-01 0
2013: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3,485
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,910
Total of all active and inactive participants 2013-01-01 2,910
Total participants 2013-01-01 0
2012: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3,823
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3,485
Total of all active and inactive participants 2012-01-01 3,485
Total participants 2012-01-01 0
2011: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3,797
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3,823
Total of all active and inactive participants 2011-01-01 3,823
Total participants 2011-01-01 3,823
2010: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 3,234
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3,797
Total of all active and inactive participants 2010-01-01 3,797
Total participants 2010-01-01 3,797
2009: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3,886
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3,234
Total of all active and inactive participants 2009-01-01 3,234
Total participants 2009-01-01 3,234

Measure	Date	Value
2023: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	4,360
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	3,928
Total of all active and inactive participants	2023-01-01	3,928
Total participants	2023-01-01	3,928
2022: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	4,360
Total of all active and inactive participants	2022-01-01	4,360
Total participants	2022-01-01	4,360
2021: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	4,886
Total of all active and inactive participants	2021-01-01	4,886
Total participants	2021-01-01	4,886
2020: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	4,886
Total of all active and inactive participants	2020-01-01	4,886
Total participants	2020-01-01	4,886
2019: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	4,886
Total of all active and inactive participants	2019-01-01	4,886
Total participants	2019-01-01	4,886
Number of participants with account balances	2019-01-01	0
2018: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	4,886
Total of all active and inactive participants	2018-01-01	4,886
Total participants	2018-01-01	4,886
2017: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	4,886
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	4,886
Total of all active and inactive participants	2017-01-01	4,886
Total participants	2017-01-01	4,886
2016: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	4,886
Total of all active and inactive participants	2016-01-01	4,886
Total participants	2016-01-01	4,886
2015: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	4,026
Total of all active and inactive participants	2015-01-01	4,026
Total participants	2015-01-01	0
2014: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,910
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3,299
Total of all active and inactive participants	2014-01-01	3,299
Total participants	2014-01-01	0
2013: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,485
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,910
Total of all active and inactive participants	2013-01-01	2,910
Total participants	2013-01-01	0
2012: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3,823
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3,485
Total of all active and inactive participants	2012-01-01	3,485
Total participants	2012-01-01	0
2011: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3,797
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3,823
Total of all active and inactive participants	2011-01-01	3,823
Total participants	2011-01-01	3,823
2010: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	3,234
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3,797
Total of all active and inactive participants	2010-01-01	3,797
Total participants	2010-01-01	3,797
2009: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3,886
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3,234
Total of all active and inactive participants	2009-01-01	3,234
Total participants	2009-01-01	3,234

Form 5500 Responses for KNIGHT TRANSPORTATION, INC CAFETERIA PLAN

2023: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2020: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2019: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2018: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2015: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2014: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2013: KNIGHT TRANSPORTATION, INC CAFETERIA 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 benefit arrangement – Insurance	Yes
2012: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: KNIGHT TRANSPORTATION, INC CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

4823

Policy instance

Insurance contract or identification number	4823
Number of Individuals Covered	3928
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

XM4-001, COB

Policy instance

Insurance contract or identification number	XM4-001, COB
Number of Individuals Covered	3389
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $18,380
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,798
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

029653

Policy instance

Insurance contract or identification number	029653
Number of Individuals Covered	3674
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $415,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010267724

Policy instance

Insurance contract or identification number	000010267724
Number of Individuals Covered	1413
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $64,123
Total amount of fees paid to insurance company	USD $9,534
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $427,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010267723

Policy instance

Insurance contract or identification number	000010267723
Number of Individuals Covered	1059
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $69,058
Total amount of fees paid to insurance company	USD $10,232
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $460,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010267722

Policy instance

Insurance contract or identification number	000010267722
Number of Individuals Covered	3628
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $206,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00400001000

Policy instance

Insurance contract or identification number	00400001000
Number of Individuals Covered	907
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $84,770
Total amount of fees paid to insurance company	USD $1,029
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $565,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000403007976

Policy instance

Insurance contract or identification number	000403007976
Number of Individuals Covered	907
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,433
Total amount of fees paid to insurance company	USD $98
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,554
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

XM4-001, COB

Policy instance

Insurance contract or identification number	XM4-001, COB
Number of Individuals Covered	3977
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $19,948
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $199,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,948
Insurance broker organization code?	3

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

Policy contract number

029653

Policy instance

Insurance contract or identification number	029653
Number of Individuals Covered	4522
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $466,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

4823

Policy instance

Insurance contract or identification number	4823
Number of Individuals Covered	4564
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

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

Policy contract number

000010267723

Policy instance

Insurance contract or identification number	000010267723
Number of Individuals Covered	1191
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $57,492
Total amount of fees paid to insurance company	USD $30,725
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $383,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,752
Amount paid for insurance broker fees	9237
Additional information about fees paid to insurance broker	FINDERS FEE, CONSULTING
Insurance broker organization code?	3

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

Policy contract number

000010267722

Policy instance

Insurance contract or identification number	000010267722
Number of Individuals Covered	4360
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $4,334
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4334
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000403007976

Policy instance

Insurance contract or identification number	000403007976
Number of Individuals Covered	1265
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,474
Total amount of fees paid to insurance company	USD $4,564
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $49,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,259
Amount paid for insurance broker fees	351
Additional information about fees paid to insurance broker	FINDERS FEE
Insurance broker organization code?	3

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

Policy contract number

000010267724

Policy instance

Insurance contract or identification number	000010267724
Number of Individuals Covered	1670
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $48,721
Total amount of fees paid to insurance company	USD $29,925
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $360,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,588
Amount paid for insurance broker fees	8598
Additional information about fees paid to insurance broker	FINDERS FEE, CONSULTING
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	1265
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $77,691
Total amount of fees paid to insurance company	USD $22,880
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $517,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,801
Amount paid for insurance broker fees	3653
Additional information about fees paid to insurance broker	FINDERS FEE
Insurance broker organization code?	3

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

Policy contract number

029653

Policy instance

Insurance contract or identification number	029653
Number of Individuals Covered	4332
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $499,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4886
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,359
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $21,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,003
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	806
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $55,104
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $333,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,529
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1191
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $53,980
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $327,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,651
Insurance broker organization code?	3

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	4074
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $20,984
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $209,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,984
Insurance broker organization code?	3

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

0482300000

Policy instance

Insurance contract or identification number	0482300000
Number of Individuals Covered	2400
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

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	5604
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $67,468
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $470,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,306
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	5604
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $43,233
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $326,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,233
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4886
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $19,935
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $20,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,935
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	806
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66,140
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,140
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1191
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $51,999
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $346,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,999
Insurance broker organization code?	3

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3987
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $20,991
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $209,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,991
Insurance broker organization code?	3

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

Policy contract number

029653

Policy instance

Insurance contract or identification number	029653
Number of Individuals Covered	2380
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $883,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

0482300000

Policy instance

Insurance contract or identification number	0482300000
Number of Individuals Covered	2591
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	4361
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $21,601
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,601
Insurance broker organization code?	3

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

Policy contract number

029653

Policy instance

Insurance contract or identification number	029653
Number of Individuals Covered	2435
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $908,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4886
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $19,935
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $17,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,935
Insurance broker organization code?	3

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

0482300000

Policy instance

Insurance contract or identification number	0482300000
Number of Individuals Covered	2627
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	806
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $69,999
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $355,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,999
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	5604
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $53,885
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $329,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,885
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1191
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $58,936
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $303,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,936
Insurance broker organization code?	3

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

Policy contract number

29653

Policy instance

Insurance contract or identification number	29653
Number of Individuals Covered	2382
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $138,570
Total amount of fees paid to insurance company	USD $1,350
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $927,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138,570
Amount paid for insurance broker fees	1350
Additional information about fees paid to insurance broker	MEALS, GIFTS & TICKETS
Insurance broker organization code?	3

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4886
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $132,344
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $966,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132,344
Amount paid for insurance broker fees	132344
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

04823 00000

Policy instance

Insurance contract or identification number	04823 00000
Number of Individuals Covered	2388
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3918
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $20,116
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $201,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,116

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

04823 00000

Policy instance

Insurance contract or identification number	04823 00000
Number of Individuals Covered	2304
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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

29653

Policy instance

Insurance contract or identification number	29653
Number of Individuals Covered	2412
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $123,382
Total amount of fees paid to insurance company	USD $141
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,268,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $123,382
Amount paid for insurance broker fees	141
Additional information about fees paid to insurance broker	NON-MONETARY BROKER COMPENSATION, SPECIAL MONETARY INCENTIVES, GIFTS, GRATUITIES, AND MEALS
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES LLC

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3752
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $21,217
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $212,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,217
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES LLC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	5604
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $141,248
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,026,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $141,248
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

141546

Policy instance

Insurance contract or identification number	141546
Number of Individuals Covered	39
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $414
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $414
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

144123

Policy instance

Insurance contract or identification number	144123
Number of Individuals Covered	196
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $3,098
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $14,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,098
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

0847075

Policy instance

Insurance contract or identification number	0847075
Number of Individuals Covered	4458
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,226,748
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

29653

Policy instance

Insurance contract or identification number	29653
Number of Individuals Covered	2285
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $128,573
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,244,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,573
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3647
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $19,891
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,891
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	809
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $48,807
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,990
Insurance broker organization code?	3
Insurance broker name	DULEY BOLWAR ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1191
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $39,389
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $262,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,389
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4026
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $16,826
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	4824
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $73,589
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $557,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,323
Insurance broker organization code?	3
Insurance broker name	DULEY-BOLWAR ASSOCIATES INC

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

Policy contract number

R0389569

Policy instance

Insurance contract or identification number	R0389569
Number of Individuals Covered	3
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $81
Other welfare benefits provided	GCI (EE)
Welfare Benefit Premiums Paid to Carrier	USD $754
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
Insurance broker name	DUANE A BOLWAR JR

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3468
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $17,239
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $172,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,239
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

29653

Policy instance

Insurance contract or identification number	29653
Number of Individuals Covered	2149
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $107,649
Total amount of fees paid to insurance company	USD $117
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,049,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,649
Amount paid for insurance broker fees	117
Additional information about fees paid to insurance broker	MEALS, GIFTS & TICKETS
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	688
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $54,431
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,931
Insurance broker organization code?	3
Insurance broker name	DULEY BOLWAR & ASSOCIATES

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

Policy contract number

0847075

Policy instance

Insurance contract or identification number	0847075
Number of Individuals Covered	4468
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of fees paid to insurance company	USD $65,288
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,064,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	40638
Additional information about fees paid to insurance broker	2013/2014 MM P3 BONUS
Insurance broker organization code?	3
Insurance broker name	DULEY BOLWAR & ASSOCIATES

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	3299
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $15,354
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	3917
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $81,478
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $518,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,893
Insurance broker organization code?	3
Insurance broker name	DULEY-BOLWAR ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $43,757
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $215,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,264
Insurance broker organization code?	3
Insurance broker name	DULEY BOLWAR ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	2910
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $16,182
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

29653

Policy instance

Insurance contract or identification number	29653
Number of Individuals Covered	1937
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $101,452
Total amount of fees paid to insurance company	USD $414
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $964,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $101,452
Insurance broker organization code?	3
Amount paid for insurance broker fees	414
Additional information about fees paid to insurance broker	BROKER CONFERENCE, INCENTIVE, MEALS
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

XM4-001

Policy instance

Insurance contract or identification number	XM4-001
Number of Individuals Covered	3180
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,105
Total amount of fees paid to insurance company	USD $8,147
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,105
Insurance broker organization code?	3
Amount paid for insurance broker fees	8147
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	758
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $51,033
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $340,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,033
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES LLC

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

Policy contract number

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1191
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $36,043
Total amount of fees paid to insurance company	USD $10,000
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $240,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,043
Insurance broker organization code?	3
Amount paid for insurance broker fees	10000
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker name	DULEY BOLWAR ASSOCIATES INC

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

00407-00000

Policy instance

Insurance contract or identification number	00407-00000
Number of Individuals Covered	1900
Insurance policy start date	2013-01-01
Insurance policy end date	2013-11-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,074,067
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	3646
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $58,203
Total amount of fees paid to insurance company	USD $24,138
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $473,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,203
Insurance broker organization code?	3
Amount paid for insurance broker fees	24138
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker name	DULEY-BOLWAR ASSOCIATES INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

141546

Policy instance

Insurance contract or identification number	141546
Number of Individuals Covered	40
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $353
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $353
Insurance broker organization code?	3
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

144123

Policy instance

Insurance contract or identification number	144123
Number of Individuals Covered	193
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $9,077
Total amount of fees paid to insurance company	USD $1,752
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $45,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	396
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $9,077
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

119477

Policy instance

Insurance contract or identification number	119477
Number of Individuals Covered	763
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $46,975
Total amount of fees paid to insurance company	USD $12,578
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $313,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2349
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $46,975
Insurance broker name	ANDY BOLWAR & ASSOCIATES, INC

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

Policy contract number

137338

Policy instance

Insurance contract or identification number	137338
Number of Individuals Covered	1195
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $13,293
Total amount of fees paid to insurance company	USD $9,531
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	665
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $13,293
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

533449

Policy instance

Insurance contract or identification number	533449
Number of Individuals Covered	3485
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of fees paid to insurance company	USD $4,175
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	820
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	GRIFFIN, STEVEN RAY

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

00407-00000

Policy instance

Insurance contract or identification number	00407-00000
Number of Individuals Covered	1796
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,049,825
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	1985
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Welfare Benefit Premiums Paid to Carrier	USD $974,688
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

137339

Policy instance

Insurance contract or identification number	137339
Number of Individuals Covered	625
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3310556

Policy instance

Insurance contract or identification number	3310556
Number of Individuals Covered	3808
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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

137338

Policy instance

Insurance contract or identification number	137338
Number of Individuals Covered	1786
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $43,532
Total amount of fees paid to insurance company	USD $2,177
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $290,212
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

119477

Policy instance

Insurance contract or identification number	119477
Number of Individuals Covered	601
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $42,445
Total amount of fees paid to insurance company	USD $2,122
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $282,963
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

137339

Policy instance

Insurance contract or identification number	137339
Number of Individuals Covered	1584
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $79,114
Total amount of fees paid to insurance company	USD $3,956
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $527,426
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	2049
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Welfare Benefit Premiums Paid to Carrier	USD $917,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

00407-00000

Policy instance

Insurance contract or identification number	00407-00000
Number of Individuals Covered	1986
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $986,040
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

144123

Policy instance

Insurance contract or identification number	144123
Number of Individuals Covered	194
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $10,337
Total amount of fees paid to insurance company	USD $994
Other welfare benefits provided	LONG-TERM CARE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $49,686
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

533449

Policy instance

Insurance contract or identification number	533449
Number of Individuals Covered	3823
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of fees paid to insurance company	USD $1,005
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,015
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

66803-6

Policy instance

Insurance contract or identification number	66803-6
Number of Individuals Covered	2058
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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

137339

Policy instance

Insurance contract or identification number	137339
Number of Individuals Covered	1277
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $59,836
Total amount of fees paid to insurance company	USD $7,978
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $398,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7978
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $59,836
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

137338

Policy instance

Insurance contract or identification number	137338
Number of Individuals Covered	1267
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $29,285
Total amount of fees paid to insurance company	USD $3,905
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3905
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $29,285
Insurance broker name	ANDY BOLWAR & ASSOCIATES INC

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

Policy contract number

533449

Policy instance

Insurance contract or identification number	533449
Number of Individuals Covered	3797
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of fees paid to insurance company	USD $1,247
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $124,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1247
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	DULEY-BOLWAR ASSOCIATES INC

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

00407-00000

Policy instance

Insurance contract or identification number	00407-00000
Number of Individuals Covered	1050
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $991,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	KNIGHT TRANSPORTATION, INC
Employer identification number (EIN):	860649974
NAIC Classification:	484120
NAIC Description:	General Freight Trucking, Long-Distance

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1993-06-14
Company Identification Number:	1734405
Legal Registered Office Address:	2290 STATE ROUTE 48 Oswego FULTON United States of America (USA) 13069