Schedule A
- Row 1
- Filing Id
- 84037218239057
- Form Id
- 79780065
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050005
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $45,808
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 84037218239057
- Form Id
- 79780068
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050008
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF TEXAS
- Ins Broker 01 Street Addr
- 1445 ROSS AVENUE SUITE 4200
- Ins Broker 01 City
- DALLAS
- Ins Broker 01 State
- TX
- Ins Broker 01 ZIP Code
- 75202
- Ins Broker Comm Pd 01 Amount
- $5,515
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 84037218239057
- Form Id
- 79780064
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050004
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $7,921
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 84037218239057
- Form Id
- 79780063
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050003
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $8,042
- Ins Broker Fees Pd 01 Amount
- $1,378
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 5
- Filing Id
- 84037218239057
- Form Id
- 79780062
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050002
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $7,507
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 6
- Filing Id
- 84037218239057
- Form Id
- 79780067
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050007
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $6,898
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 7
- Filing Id
- 84037218239057
- Form Id
- 79780066
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 6010377218239050006
- Ins Broker 01 Name
- SUMMIT GLOBAL PARTNERS OF FLORIDA
- Ins Broker 01 Street Addr
- 200 W CYPRESS CREEK ROAD
- Ins Broker 01 City
- FT LAUDERDALE
- Ins Broker 01 State
- FL
- Ins Broker 01 ZIP Code
- 33309
- Ins Broker Comm Pd 01 Amount
- $2,023
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- SALES AND SERVICE
- Ins Broker 01 Code
- 3
- Row 8
- Ins Carrier Name: JEFFERSON PILOT FINANCIAL INSURANCE COMPANY
- Filing Id
- 84037218239057
- Form Id
- 79780063
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- JEFFERSON PILOT FINANCIAL INSURANCE COMPANY
- Ins Carrier EIN
- 62-0395665
- Ins Carrier Naic Code
- 70254
- Ins Contract Num
- 10064762
- Ins Prsn Covered End of year Count
- 403
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $8,042
- Ins Broker Fees Total Amount
- $1,378
- 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
- ACCIDENTAL DEATH AND DISMEMBERMENT
- 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
- $53,167
- Wlfr Acquis Cost Amount
- $0
- Row 9
- Ins Carrier Name: COMPBENEFITS COMPANY
- Filing Id
- 84037218239057
- Form Id
- 79780067
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- COMPBENEFITS COMPANY
- Ins Carrier EIN
- 59-2531815
- Ins Carrier Naic Code
- 52015
- Ins Contract Num
- 57600/CD4105
- Ins Prsn Covered End of year Count
- 400
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $6,898
- 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
- $75,626
- Wlfr Acquis Cost Amount
- $0
- Row 10
- Ins Carrier Name: COMMUNITY CARE LIFE AND HEALTH
- Filing Id
- 84037218239057
- Form Id
- 79780068
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- COMMUNITY CARE LIFE AND HEALTH
- Ins Carrier EIN
- 73-1580741
- Ins Carrier Naic Code
- 89008
- Ins Contract Num
- SA1101
- Ins Prsn Covered End of year Count
- 28
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $5,515
- 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
- $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
- $104,471
- Wlfr Acquis Cost Amount
- $0
- Row 11
- Ins Carrier Name: EYEMED VISION CARE
- Filing Id
- 84037218239057
- Form Id
- 79780066
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- EYEMED VISION CARE
- Ins Carrier EIN
- 43-0949844
- Ins Carrier Naic Code
- 71870
- Ins Contract Num
- 9648452
- Ins Prsn Covered End of year Count
- 428
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $2,023
- 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
- C
- 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
- $25,707
- Wlfr Acquis Cost Amount
- $0
- Row 12
- Ins Carrier Name: AETNA LIFE INSURANCE COMPANY
- Filing Id
- 84037218239057
- Form Id
- 79780062
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- AETNA LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 06-6033492
- Ins Carrier Naic Code
- 95003
- Ins Contract Num
- 500259
- Ins Prsn Covered End of year Count
- 310
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $7,507
- 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
- ABCDE
- 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
- $166,517
- Wlfr Acquis Cost Amount
- $0
- Row 13
- Ins Carrier Name: HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.
- Filing Id
- 84037218239057
- Form Id
- 79780064
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.
- Ins Carrier EIN
- 61-1041514
- Ins Carrier Naic Code
- 69671
- Ins Contract Num
- M5147
- Ins Prsn Covered End of year Count
- 10
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $7,921
- 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
- $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
- $156,371
- Wlfr Acquis Cost Amount
- $0
- Row 14
- Ins Carrier Name: HUMANA MEDICAL PLAN, INC.
- Filing Id
- 84037218239057
- Form Id
- 79780065
- Schedule A EIN
- 65-0420554
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2006-01-01
- Schedule A Tax Period
- 20061231
- Ins Carrier Name
- HUMANA MEDICAL PLAN, INC.
- Ins Carrier EIN
- 61-1103898
- Ins Carrier Naic Code
- 95270
- Ins Contract Num
- M5146
- Ins Prsn Covered End of year Count
- 213
- Ins Policy From Date
- 2005-11-01
- Ins Policy To Date
- 2006-10-31
- Ins Broker Comm Total Amount
- $45,808
- 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
- $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
- $974,409
- Wlfr Acquis Cost Amount
- $0