Schedule A
- Row 1
- Filing Id
- 56037124164301
- Form Id
- 4509765
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20371124164050004
- Ins Broker 01 Name
- GAYLE T. MILTON
- Ins Broker 01 Street Addr
- 200 WEST COURT SQUARE, STE. 2
- Ins Broker 01 City
- HUNTSVILLE
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35801
- Ins Broker Comm Pd 01 Amount
- $2,451
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 56037124164301
- Form Id
- 4509767
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20371124164050006
- Ins Broker 01 Name
- GAYLE TANLEY MILTON
- Ins Broker 01 Street Addr
- 200 WEST COURT SQUARE, SUITE 5
- Ins Broker 01 City
- HUNTSVILLE
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35801
- Ins Broker Comm Pd 01 Amount
- $2,941
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- WILLIAM FULLER
- Ins Broker 01 Street Addr
- P.O. BOX 4071
- Ins Broker 01 City
- HUNTSVILLE
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35802
- Ins Broker Comm Pd 01 Amount
- $4
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 56037124164301
- Form Id
- 4509766
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20371124164050005
- Ins Broker 01 Name
- GAYLE TANLEY MILTON
- Ins Broker 01 Street Addr
- 200 WEST COURT SQUARE, SUITE 5
- Ins Broker 01 City
- HUNTSVILLE
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35801
- Ins Broker Comm Pd 01 Amount
- $694
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 5
- Filing Id
- 56037124164301
- Form Id
- 4509764
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20371124164050003
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 6
- Filing Id
- 56037124164301
- Form Id
- 4509765
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 20371124164050004
- Ins Broker 01 Name
- JOSEPH S. LAWRENCE
- Ins Broker 01 Street Addr
- 285 KELLY SPRING RD.
- Ins Broker 01 City
- HARVEST
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 357498663
- Ins Broker Comm Pd 01 Amount
- $2,451
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 7
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- PEGGY EGAN
- Ins Broker 01 Street Addr
- P.O. BOX 4544
- Ins Broker 01 City
- SAVANNAH
- Ins Broker 01 State
- GA
- Ins Broker 01 ZIP Code
- 21402
- Ins Broker Comm Pd 01 Amount
- $180
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 8
- Filing Id
- 56037124164301
- Form Id
- 4509766
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 20371124164050005
- Ins Broker 01 Name
- JOSEPH S. LAWRENCE
- Ins Broker 01 Street Addr
- 285 KELLY SPRING ROAD
- Ins Broker 01 City
- HARVEST
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35749
- Ins Broker Comm Pd 01 Amount
- $694
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 9
- Filing Id
- 56037124164301
- Form Id
- 4509767
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 20371124164050006
- Ins Broker 01 Name
- JOSEPH S. LAWRENCE
- Ins Broker 01 Street Addr
- 285 KELLY SPRING ROAD
- Ins Broker 01 City
- HARVEST
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35749
- Ins Broker Comm Pd 01 Amount
- $2,941
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 10
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 2
- Row Num
- 10
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- CHRIS WILSON
- Ins Broker 01 Street Addr
- 7886 HUNTER'S CROSSING
- Ins Broker 01 City
- CORDOVA
- Ins Broker 01 State
- TN
- Ins Broker 01 ZIP Code
- 38018
- Ins Broker Comm Pd 01 Amount
- $2,903
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 11
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 3
- Row Num
- 11
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- JAMES ZANONE
- Ins Broker 01 Street Addr
- 777 MT. MORIAH ROAD
- Ins Broker 01 City
- MEMPHIS
- Ins Broker 01 State
- TN
- Ins Broker 01 ZIP Code
- 38117
- Ins Broker Comm Pd 01 Amount
- $32
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 12
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 2
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- CARLTON REID, JR.
- Ins Broker 01 Street Addr
- P.O. BOX 1674
- Ins Broker 01 City
- BRUNSWICK
- Ins Broker 01 State
- GA
- Ins Broker 01 ZIP Code
- 31521
- Ins Broker Comm Pd 01 Amount
- $63
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 13
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 1
- Row Num
- 3
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- SHIRLEE BLEVINS
- Ins Broker 01 Street Addr
- 814 LONGBOW DRIVE
- Ins Broker 01 City
- DECATUR
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35603
- Ins Broker Comm Pd 01 Amount
- $142
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 14
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 2
- Row Num
- 4
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- ANNA REID
- Ins Broker 01 Street Addr
- ROUTE 1, BOX 326
- Ins Broker 01 City
- REIDSVILLE
- Ins Broker 01 State
- GA
- Ins Broker 01 ZIP Code
- 30453
- Ins Broker Comm Pd 01 Amount
- $508
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 15
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 3
- Row Num
- 5
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- MAURICE MOORE
- Ins Broker 01 Street Addr
- 4538 BONNEY ROAD
- Ins Broker 01 City
- VIRGINIA BEACH
- Ins Broker 01 State
- VA
- Ins Broker 01 ZIP Code
- 23462
- Ins Broker Comm Pd 01 Amount
- $19
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 16
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 1
- Row Num
- 6
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- CATHERINE EDWARDS
- Ins Broker 01 Street Addr
- P.O. BOX 17392
- Ins Broker 01 City
- MEMPHIS
- Ins Broker 01 State
- TN
- Ins Broker 01 ZIP Code
- 38167
- Ins Broker Comm Pd 01 Amount
- $863
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 17
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 2
- Row Num
- 7
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- THOMAS SIDLEY
- Ins Broker 01 Street Addr
- 814 LONGBOW DRIVE
- Ins Broker 01 City
- DECATUR
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35603
- Ins Broker Comm Pd 01 Amount
- $14
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 18
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 3
- Row Num
- 8
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- DONALD GINGLES
- Ins Broker 01 Street Addr
- 4466 FAIRLAKES COURT
- Ins Broker 01 City
- FAIRFAX
- Ins Broker 01 State
- VA
- Ins Broker 01 ZIP Code
- 22033
- Ins Broker Comm Pd 01 Amount
- $329
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 19
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 1
- Row Num
- 9
- Image Form Id
- 20371124164050002
- Ins Broker 01 Name
- ERROL MCCLADDLE
- Ins Broker 01 Street Addr
- 2010 FLAGSTONE DRIVE
- Ins Broker 01 City
- MADISON
- Ins Broker 01 State
- AL
- Ins Broker 01 ZIP Code
- 35758
- Ins Broker Comm Pd 01 Amount
- $5,972
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 20
- Ins Carrier Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
- Filing Id
- 56037124164301
- Form Id
- 4509765
- Schedule A EIN
- 63-1004214
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- RELIANCE STANDARD LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 36-0883760
- Ins Carrier Naic Code
- 68381
- Ins Contract Num
- 136-1572
- Ins Prsn Covered End of year Count
- 340
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $4,902
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- B
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $138,909
- Wlfr Acquis Cost Amount
- $0
- Row 21
- Ins Carrier Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
- Filing Id
- 56037124164301
- Form Id
- 4509766
- Schedule A EIN
- 63-1004214
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- RELIANCE STANDARD LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 36-0883760
- Ins Carrier Naic Code
- 68381
- Ins Contract Num
- GL028499
- Ins Prsn Covered End of year Count
- 799
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $1,388
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DM
- Wlfr Type Bnft Oth Text
- AD&D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $13,862
- Wlfr Acquis Cost Amount
- $0
- Row 22
- Filing Id
- 56037124164301
- Form Id
- 4509764
- Schedule A EIN
- 63-1004214
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- A
- Wlfr Premium Rcvd Amount
- $982,230
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $982,230
- Wlfr Claims Paid Amount
- $817,694
- Wlfr Incr Reserve Amount
- $43,100
- Wlfr Incurred Claim Amount
- $860,794
- Wlfr Claims Chrgd Amount
- $860,794
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $93,613
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $15,716
- Wlfr Ret Charges Amount
- $44,194
- Wlfr Ret Oth Chrgs Amount
- $-14,734
- Wlfr Ret Total Amount
- $138,789
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $103,300
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $27,369
- Wlfr Acquis Cost Amount
- $0
- Row 23
- Filing Id
- 56037124164301
- Form Id
- 4509763
- Schedule A EIN
- 63-1004214
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- M
- Wlfr Type Bnft Oth Text
- CANCER
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $46,900
- Wlfr Acquis Cost Amount
- $0
- Row 24
- Ins Carrier Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
- Filing Id
- 56037124164301
- Form Id
- 4509767
- Schedule A EIN
- 63-1004214
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- RELIANCE STANDARD LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 36-0883760
- Ins Carrier Naic Code
- 68381
- Ins Contract Num
- LTD099059
- Ins Prsn Covered End of year Count
- 799
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $5,882
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- No
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $53,991
- Wlfr Acquis Cost Amount
- $0