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SELF-INSURANCE INSTITUTE OF AMERICA, INC. PAC (SELF-INSURANCE PAC)

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The query you have chosen matched 683 individual contributions.

Contributor City State ZIP Date Amount Employer/Occupation Image Number

CONTRIBUTIONS FROM AN INDIVIDUAL

ANTONELL, JOSEPH M MIAMI FL 33156 04/14/2016 1000.00 A&M INTL. HEALTH PLAN 201607129020413629

ANTONELL, JOSEPH M MIAMI FL 33156 06/22/2017 500.00 A&M INTL. HEALTH PLAN 201805099112002194

ARCHER, TODD EDMUND OK 73025 08/27/2018 500.00 HEALTHSCOPE BENEFITS 201810239130757881

ARCHER, TODD EDMUND OK 73025 03/03/2018 1000.00 HEALTHSCOPE BENEFITS 201805099112002376

ARCHER, TODD E. AUSTIN TX 78729 05/15/2017 1000.00 BOON-CHAPMAN BENEFIT ADMIN. 201805099112002194

ARCHER, TODD EDWARD OKLAHOMA CITY OK 73134 02/26/2016 1000.00 HEALTHSMART 201604129012296988

ATKINSON, BRIAN WAYNE PA 19087 04/06/2018 1000.00 ELAP SERVICES 201808279121530791

AUGUSTINE, JOHN SOUTHAMPTN PA 18966 05/03/2016 1000.00 WELLNET 201607129020413629

AXTELL, GENE MR. FOLSOM CA 95630 04/05/2011 1000.00 AFFINITY GROUP ADMINISTRATORS 12950220090

BAEZ, ARMANDO LAGUNA BEACH CA 92651 03/21/2018 250.00 GLOBAL BENEFITS GROUP 201805099112002376

BAEZ, RICARDO ROCKVILLE CENTRE NY 11570 09/16/2011 500.00 STEWART, GREENBLATT, MANNING & 12970139402

BAISDEN, BOB FRANKLIN TN 37064 01/16/2013 500.00 INTERNATIONAL ASSURANCE OF TEN 13964043854

BAISDEN, BOB FRANKLIN TN 37064 03/08/2016 1000.00 INTERNATIONAL ASSURANCE OF TEN 201604129012296988

BAISDEN, BOB FRANKLIN TN 37064 04/16/2014 500.00 INTERNATIONAL ASSURANCE OF TEN 14961549238

BAISDEN, BOB FRANKLIN TN 37064 08/21/2012 500.00 INTERNATIONAL ASSURANCE OF TEN 13940103767

BAISDEN, BOB FRANKLIN TN 37064 09/19/2012 1000.00 INTERNATIONAL ASSURANCE OF TEN 13940103767

BAISDEN, BRANDON FRANKLIN TN 37067 08/21/2012 500.00 INTERNATIONAL ASSURANCE OF TN 13940103768

BAISDEN, BRANDON FRANKLIN TN 37067 01/18/2018 1000.00 INTERNATIONAL ASSURANCE OF TN 201805099112002376

BAISDEN, BRANDON FRANKLIN TN 37067 01/24/2017 1000.00 INTERNATIONAL ASSURANCE OF TN 201805099112002194

BAISDEN, BRANDON FRANKLIN TN 37067 04/16/2014 500.00 INTERNATIONAL ASSURANCE OF TN 14961549238

BAISDEN, BRANDON FRANKLIN TN 37067 02/12/2013 500.00 INTERNATIONAL ASSURANCE OF TN 13964043854

BARKER, ROBERT COVINGTON KY 41011 04/24/2017 250.00 KY CAPTIVE ASSOC. 201805099112002195

BARTLETT, MARILYN BILLINGS MT 59102 10/19/2011 500.00 EBMS 12970139402

BARTLETT, THOMAS EDMOND OK 73003 09/13/2018 250.00 HEALTHSCOPE BENEFITS 201810239130757881

BAYNE, RODGER MR. MONKTON MD 21111 09/26/2018 3500.00 GROUP BENEFIT SERVICES, INC. 201810239130757881

BAYNE, RODGER MR. MONKTON MD 21111 04/05/2011 500.00 GROUP BENEFIT SERVICES, INC. 12950220090

BAYNE, RODGER MR. MONKTON MD 21111 02/15/2017 2500.00 GROUP BENEFIT SERVICES, INC. 201805099112002195

BECK, JARID LONG BEACH CA 90802 05/27/2016 1000.00 RISK MANAGEMENT ADVISORS 201607129020413629

BECK, JARID LONG BEACH CA 90802 10/09/2017 5000.00 RISK MANAGEMENT ADVISORS 201805099112002349

BECK, JARID LONG BEACH CA 90802 04/18/2017 500.00 RISK MANAGEMENT ADVISORS 201805099112002195

BEELER, WILLIAM HENDERSONVILLE TN 37075 06/23/2016 1000.00 HEALTH COST SOLUTIONS 201607129020413630

BEELER, WILLIAM HENDERSONVILLE TN 37075 03/28/2017 1000.00 HEALTH COST SOLUTIONS 201805099112002196

BELDING, THOMAS EDMOND OK 73013 05/08/2017 250.00 PRO. REINSURANCE MARKETING SRV 201805099112002196

BELDING, THOMAS EDMOND OK 73013 01/16/2017 500.00 PRO. REINSURANCE MARKETING SRV 201805099112002196

BELDING, THOMAS EDMOND OK 73013 01/23/2018 2000.00 PRO. REINSURANCE MARKETING SRV 201805099112002377

BELDING, THOMAS EDMOND OK 73013 04/05/2011 500.00 PRO. REINSURANCE MARKETING SRV 12950220091

BELDING, THOMAS EDMOND OK 73013 10/20/2011 1000.00 PRO. REINSURANCE MARKETING SRV 12970139402

BELDING, THOMAS EDMOND OK 73013 01/12/2010 1000.00 PRO. REINSURANCE MARKETING SRV 10930617160

BELDING, THOMAS EDMOND OK 73013 04/13/2016 1000.00 PRO. REINSURANCE MARKETING SRV 201607129020413630

BELDING, THOMAS EDMOND OK 73013 10/08/2012 1000.00 PRO. REINSURANCE MARKETING SRV 13940103795

BELDING, THOMAS EDMOND OK 73013 04/23/2014 1500.00 PRO. REINSURANCE MARKETING SRV 14961549238

BELDING, THOMAS EDMOND OK 73013 06/23/2015 1500.00 PRO. REINSURANCE MARKETING SRV 201507139000089856

BELDING, THOMAS EDMOND OK 73013 04/19/2012 1000.00 PRO. REINSURANCE MARKETING SRV 12952264043

BELDING, THOMAS EDMOND OK 73013 02/23/2011 1000.00 PRO. REINSURANCE MARKETING SRV 12950204766

BERNHARD, JEFF BRANDON FL 33511 01/30/2017 1000.00 CONTINENTAL BENEFITS 201805099112002197

BERRY, CAROL WOODLAND HILLS CA 91367 01/11/2018 750.00 HCAA 201805099112002377

BERRY, CAROL WOODLAND HILLS CA 91367 09/24/2016 500.00 HCAA 201707069066531397

BERRY, CAROL WOODLAND HILLS CA 91367 03/06/2017 500.00 HCAA 201805099112002197

BIGSBY, BRUCE ROSWELL GA 30075 01/25/2011 500.00 GLOBALCARE, INC 12950204766

BIGSBY, BRUCE ROSWELL GA 30075 02/16/2010 500.00 GLOBALCARE, INC 10930617160

BOCEK, REBECCA WALNUT CREEK CA 94597 09/28/2012 500.00 STOP LOSS INSURANCE SERVICES 13940103768

BOLGAR, DANIEL MAPLE GROVE MN 55311 06/23/2016 1000.00 PARTNER RE 201607129020413630

BORANS, PETER LYNNFIELD MA 01940 03/07/2016 1000.00 ADVANCED MEDICAL STRATEGIES 201604129012296988

BORANS, PETER LYNNFIELD MA 01940 03/08/2016 1000.00 ADVANCED MEDICAL STRATEGIES 201604129012296989

BORANS, STACY CHALFONT PA 18914 04/19/2018 2000.00 ADVANCED MEDICAL STRATEGIES 201808279121530791

BOUGHNER, LESLIE HIGHLAND PARK IL 60035 10/19/2011 500.00 WILLIS 12970139403

BOUGHNER, LESLIE HIGHLAND PARK IL 60035 01/05/2010 250.00 WILLIS 10930617160

BOUGHNER, LESLIE CHARLESTON SC 29401 02/27/2018 250.00 ADVANTAGE INSURANCE MANAGEMENT 201805099112002377

BOUGHNER, LESLIE HIGHLAND PARK IL 60035 03/25/2016 250.00 WILLIS 201604129012296989

BOUGHNER, LESLIE CHARLESTON SC 29401 09/20/2017 250.00 ADVANTAGE INSURANCE MANAGEMENT 201805099112002349

BOUGHNER, LESLIE CHARLESTON SC 29401 03/09/2017 500.00 ADVANTAGE INSURANCE MANAGEMENT 201805099112002197

BOUGHNER, LESLIE HIGHLAND PARK IL 60035 10/08/2012 500.00 WILLIS 13940103795

BRANCO, MICHAEL BRAINTREE MA 02184 01/18/2017 1350.00 THE PHIA GROUP 201805099112002198

BRANCO, MICHAEL BRAINTREE MA 02184 03/29/2016 1000.00 THE PHIA GROUP 201604129012296989

BRANCO, MICHAEL HANOVER MA 02339 04/19/2018 1500.00 THE PHIA GROUP 201808279121530791

BROWN, CHRISTOPHER HOLDEN MA 01520 04/21/2016 1000.00 BERKLEY ACCIDENT & HEALTH 201607129020413631

BROWN, CHRISTOPHER HOLDEN MA 01520 06/09/2015 500.00 BERKLEY ACCIDENT & HEALTH 201507139000089856

BROWN, CHRISTOPHER HOLDEN MA 01520 09/19/2014 250.00 BERKLEY ACCIDENT & HEALTH 15970013734

BROWN, CHRISTOPHER HOLDEN MA 01520 09/26/2012 250.00 BERKLEY ACCIDENT & HEALTH 13940103768

BROWN, CHRISTOPHER HOLDEN MA 01520 09/12/2018 100.00 BERKLEY ACCIDENT & HEALTH 201810239130757882

BROWN, CHRISTOPHER HOLDEN MA 01520 02/12/2018 1000.00 BERKLEY ACCIDENT & HEALTH 201805099112002378

BROWN, CHRISTOPHER HOLDEN MA 01520 03/10/2017 1000.00 BERKLEY ACCIDENT & HEALTH 201805099112002198

BUECHLER, WILLIAM FRANKLIN TN 37067 06/23/2016 500.00 CROWE HORWATH 201607129020413631

BUNTING, KIMBERLY MARIETTA GA 30062 05/30/2018 1000.00 RIVER OAK RISK, LLC 201808279121530792

BURD, RICHARD LANCASTER PA 17601 04/11/2017 250.00 CONTRIBUTION HEALTH 201805099112002198

BURGESS, JOE RENO NV 89519 01/05/2010 250.00 CHSI 10930617161

BURGESS, JOE RENO NV 89519 05/20/2011 250.00 CHSI 12950220091

BURGESS, VICKI RICHARDSON TX 75082 06/22/2016 1000.00 CRUM & FORSTER 201607129020413631

BURGESS, VICKI RICHARDSON TX 75082 02/16/2018 1000.00 CRUM & FORSTER 201805099112002378

BURGESS, VICKI RICHARDSON TX 75082 03/28/2017 1000.00 CRUM & FORSTER 201805099112002199

BURKHOLDER, JAMES FAIR OAKS RANCH TX 78015 03/30/2010 500.00 TPA BENEFITS, INC. 10930617161

BUSCH, CHARLES IRVING TX 75039 03/22/2017 500.00 HEALTHSMART 201805099112002199

BYRD, TOM DULUTH GA 30097 12/30/2016 500.00 GROUP RESOURCES 201707069066531442

CALDWELL, CHARLES OKLAHOMA CITY OK 73112 11/12/2010 500.00 MIDLANDS MANAGEMENT CORPORATIO 11931583244

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 01/23/2018 1500.00 MIDLANDS MANAGEMENT CORPORATIO 201805099112002378

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 09/05/2017 1000.00 MIDLANDS MANAGEMENT CORPORATIO 201805099112002349

CALDWELL, CHARLES OKLAHOMA CITY OK 73112 04/05/2011 500.00 MIDLANDS MANAGEMENT CORPORATIO 12950220091

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 04/13/2016 1000.00 MIDLANDS MANAGEMENT CORPORATIO 201607129020413632

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 10/09/2015 500.00 MIDLANDS MANAGEMENT CORPORATIO 201601219004554635

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 05/21/2014 500.00 MIDLANDS MANAGEMENT CORPORATIO 14961549239

CALDWELL, CHARLES OKLAHOMA CITY OK 73116 04/22/2013 500.00 MIDLANDS MANAGEMENT CORPORATIO 13964043854

CALIENDO, DEREK SCOTTSDALE AZ 85258 08/31/2017 250.00 PREFERRED MEDICAL CLAIM SOLUTI 201805099112002350

CALIENDO, PAUL F LAKE OSWEGO OR 97034 10/23/2015 500.00 PREFERRED MEDICAL CLAIM SOLUTI 201601219004554635

CALLIHAN, JOEL EPHRATA PA 17522 04/04/2018 1000.00 BENECON 201808279121530792

CAPASSO, JOHN MARLTON NJ 08053 02/06/2017 1000.00 CAPTIVE PLANNING ASSOC. 201805099112002199

CAPASSO, JOHN MARLTON NJ 08053 02/22/2018 1000.00 CAPTIVE PLANNING ASSOC. 201805099112002379

CAPASSO, JOHN MARLTON NJ 08053 06/10/2016 1000.00 CAPTIVE PLANNING ASSOC. 201607129020413632

CARLSON, AMY LAGANGE IL 60525 03/16/2012 1000.00 ZURICH 12951349445

CASTELLOE, JERRY L CHARLOTTE NC 28210 02/13/2017 1000.00 CASTELLOE PARTNERS LLC 201805099112002200

CASTELLOE, JERRY L CHARLOTTE NC 28210 02/06/2018 1000.00 CASTELLOE PARTNERS LLC 201805099112002379

CASTELLOE, JERRY L CHARLOTTE NC 28210 09/28/2015 500.00 CASTELLOE PARTNERS LLC 201601219004554635

CATALANO, MARC L DAVIE FL 33325 03/13/2018 1000.00 ACA GPS 201805099112002379

CATALANO, MARC L DAVIE FL 33325 09/26/2018 500.00 ACA GPS 201810239130757882

CATALANO, MARC L DAVIE FL 33325 10/17/2017 250.00 ACA GPS 201805099112002350

CAVENAGH, ANDREW PHILADELPHIA PA 19104 09/13/2017 1000.00 PARETO CAPTIVE SERVICES 201805099112002350

CAVENAGH, ANDREW PHILADELPHIA PA 19104 04/12/2018 1000.00 PARETO CAPTIVE SERVICES, LLC 201808279121530792

CAVENAGH, ANDREW PHILADELPHIA PA 19104 06/08/2016 1000.00 PARETO CAPTIVE SERVICES 201607129020413632

CAVENAGH, ANDREW PHILADELPHIA PA 19104 05/04/2015 5000.00 PARETO CAPTIVE SERVICES 201507139000089856

CAVENAGH, ANDREW MINNEAPOLIS MN 55405 10/10/2012 500.00 PARETO CAPTIVE SERVICES 13940103795

CHANDLER, NORMAN MONTGOMERY AL 36116 06/06/2016 1000.00 ARSENAL INSURANCE MGT. 201607129020413633

CHANDLER, NORMAN MONTGOMERY AL 36116 03/20/2017 1000.00 ARSENAL INSURANCE MGT. 201805099112002200

CHAPMAN, ANNE MARIE LANSDALE PA 19446 04/04/2017 1000.00 UME 201805099112002200

CHAPMAN, KEVIN AUSTIN TX 78731 06/28/2016 500.00 BOON CHAPMAN 201607129020413633

CHAPMAN, STEVE DUBUQUE IA 52001 07/05/2018 500.00 AUXIANT 201810239130757882

CHAPMAN, STEVE DUBUQUE IA 52001 07/31/2014 250.00 AUXIANT 15970013734

CHAPMAN, STEVE DUBUQUE IA 52001 05/10/2017 500.00 AUXIANT 201805099112002201

CHAPMAN, STEVE DUBUQUE IA 52001 05/31/2013 250.00 AUXIANT 13964043855

CHAPMAN, STEVE DUBUQUE IA 52001 03/11/2016 500.00 AUXIANT 201604129012296990

CHRISTOFILIS, CHRIS MINNEAPOLIS MN 55416 01/11/2013 500.00 RISK SOLUTION RESOURCES 13964043855

CLAYTON, ANDREW PHILADELPHIA PA 19104 06/08/2016 1000.00 PARETO CAPTIVE SVCS. 201607129020413633

CLEMENTE, CRAIG R. MR. DOYLESTOWN PA 18902 01/31/2013 500.00 SPECIALTY CARE MANAGEMENT 13964043855

CLEMENTE, CRAIG R. MR. JERSEY CITY NJ 07302 10/19/2011 500.00 SPECIALTY CARE MANAGEMENT 12970139403

CLEMENTE, CRAIG R. MR. JERSEY CITY NJ 07302 01/10/2011 500.00 SPECIALTY CARE MANAGEMENT 12950204766

CLEMENTE, ROBERT WARREN NJ 07059 01/31/2013 1500.00 PAC ASSOCIATES 13964043856

CLEMENTE, ROBERT DOYLESTOWN PA 18902 03/02/2017 1100.00 SPECIALTY CARE MANAGEMENT LLC 201805099112002201

CLEMENTE, ROBERT WARREN NJ 07059 12/15/2010 500.00 PAC ASSOCIATES 11931583305

CLEMENTE, ROBERT DOYLESTOWN PA 18902 03/06/2018 1000.00 SPECIALTY CARE MANAGEMENT LLC 201805099112002380

CLEMENTE, ROBERT WARREN NJ 07059 04/19/2012 1000.00 PAC ASSOCIATES 12952264043

CLEMENTE, ROBERT WARREN NJ 07059 07/06/2016 1000.00 PAC ASSOCIATES 201707069066531397

CLEMENTE, ROBERT WARREN NJ 07059 10/20/2011 500.00 PAC ASSOCIATES 12970139403

CLEMENTE, ROBERT WARREN NJ 07059 04/05/2011 250.00 PAC ASSOCIATES 12950220092

CLEMENTE, ROBERT WARREN NJ 07059 06/03/2009 500.00 PAC ASSOCIATES 29992535253

CLEMENTE, ROBERT DOYLESTOWN PA 18902 05/02/2017 250.00 SPECIALTY CARE MANAGEMENT LLC 201805099112002201

CLEVENGER, ERNIE BRENTWOOD TN 37027 06/23/2016 1000.00 CAREHERE, LLC 201607129020413634

CLEVENGER, ERNIE BRENTWOOD TN 37027 05/26/2015 500.00 CAREHERE, LLC 201507139000089857

CLEVENGER, ERNIE BRENTWOOD TN 37027 06/30/2014 500.00 CAREHERE, LLC 14961549239

CLEVENGER, ERNIE BRENTWOOD TN 37027 01/31/2013 500.00 CAREHERE, LLC 13964043856

CLEVENGER, ERNIE BRENTWOOD TN 37027 10/08/2018 1000.00 CAREHERE, LLC 201812049133932261

CLEVENGER, ERNIE BRENTWOOD TN 37027 09/20/2012 460.00 CAREHERE, LLC 13940103769

CLEVENGER, ERNIE BRENTWOOD TN 37027 03/30/2010 500.00 CAREHERE, LLC 10930617161

CLEVENGER, ERNIE BRENTWOOD TN 37027 02/08/2017 1000.00 CAREHERE, LLC 201805099112002202

CLEVENGER, ERNIE BRENTWOOD TN 37027 01/24/2017 1000.00 CAREHERE, LLC 201805099112002202

CLEVENGER, ERNIE BRENTWOOD TN 37027 05/08/2017 250.00 CAREHERE, LLC 201805099112002202

CONKLING, JOHN AUSTIN TX 78726 10/11/2016 250.00 FRINGE BENEFIT GROUP 201707069066531420

CONKLING, JOHN AUSTIN TX 78731 08/08/2018 500.00 FRINGE BENEFIT GROUP 201810239130757883

CONSIDINE, JIM LAGUNA HILLS CA 92653 09/13/2017 250.00 CONSIDINE & ASSOCIATES HEALTHC 201805099112002351

COOK, CORI BILLINGS MT 59106 01/29/2010 500.00 EBMS 10930617162

COOK, CORI BILLINGS MT 59106 04/05/2011 300.00 EBMS 12950220092

COSTNER, J. EDWARD BRENTWOOD TN 37027 05/20/2011 500.00 CASUALTY ACTURARIAL CONSULTANT 12950220093

COWAN, AUGUSTINE ALEXANDRIA VA 22314 05/05/2016 1000.00 PYF TELEHEALTH ACCESS & SAVING 201607129020413634

COWAN, AUGUSTINE ALEXANDRIA VA 22314 09/26/2017 250.00 PYF TELEHEALTH ACCESS & SAVING 201805099112002351

COX, DAN PIPE CREEK TX 78063 10/05/2012 500.00 NATIONAL UNDERWRITING SERVICES 13940103796

CRISCIONE, JOHN SUCCASUNNA NJ 07876 03/08/2017 500.00 ETHICARE ADVISORS 201805099112002203

CROFT, THOMAS A ROSWELL GA 30075 10/08/2015 500.00 CROFT LAW LLC 201601219004554636

CULLEN, BRIAN MCHENRY IL 60050 09/24/2016 250.00 MEDCOR 201707069066531397

DABOUL, VINNIE LONGMEADOW MA 01106 08/18/2015 500.00 SAGE BENEFIT ADVISORS 201601219004554636

DAUGHERTY, LORAINE PASS A. GRILLE FL 33706 05/26/2011 250.00 PMSI 12950220093

DAVENPORT, BRYAN FRANKLIN IN 46142 01/10/2017 1000.00 LAW OFFICES OF BRYAN DAVENPORT 201805099112002203

DAVIDSON, LEE ATHOL MA 01331 04/03/2017 500.00 BERKLEY ACCIDENT & HEALTH 201805099112002203

DAY, RYAN IRVINE CA 92618 04/12/2017 1000.00 HST 201805099112002204

DECARLO, MICHAEL CHARLOTTE NC 28210 03/31/2017 3017.00 AMWINS GROUP 201805099112002204

DECARLO, MICHAEL CHARLOTTE NC 28210 06/06/2016 1000.00 AMWINS GROUP 201607129020413634

DECARLO, STEVE CHARLOTTE NC 29211 02/21/2018 3018.00 AMWINS GROUP BENEFITS 201805099112002380

DENOMA, TOM COLUMBUS OH 43026 09/26/2012 1000.00 NATIONWIDE INSURANCE 13940103769

DETELS, BRETT MARBLEHEAD MA 01945 06/14/2017 250.00 QBE NORTH AMERICA 201805099112002204

DEWSNUP, RONALD K. MISSOULA MT 59803 12/07/2015 250.00 ALLEGIANCE BENEFIT PLAN MGMT. 201601219004554636

DEWSNUP, RONALD MR. MISSOULA MT 59803 09/30/2014 250.00 ALLEGIANCE BENEFIT PLAN MNGMT 15970013735

DEWSNUP, RONALD MR. MISSOULA MT 59803 04/19/2012 250.00 ALLEGIANCE BENEFIT PLAN MNGMT 12952264043

DEWSNUP, RONALD MR. MISSOULA MT 59803 03/11/2016 500.00 ALLEGIANCE BENEFIT PLAN MNGMT 201604129012296990

DEWSNUP, RONALD MR. MISSOULA MT 59803 08/07/2017 500.00 ALLEGIANCE BENEFIT PLAN MNGMT 201805099112002351

DEWSNUP, RONALD MR. MISSOULA MT 59803 07/31/2014 250.00 ALLEGIANCE BENEFIT PLAN MNGMT 15970013734

DOHERTY, KEVIN NASHVILLE TN 37205 05/30/2018 500.00 DICKINSON WRIGHT PLLC 201808279121530793

DONLEY, CURTIS INDIANAPOLIS IN 46250 07/21/2009 250.00 DONLEY & CO 10930617151

DOVE, ERIC MOUNTAIN TOP PA 18707 06/08/2016 1000.00 ELD CONSULTING GROUP 201607129020413635

DOYLE, DENISE BOSTON MA 02116 10/06/2011 250.00 STOP LOSS INSURANCE BROKERS 12970139404

DOYLE, DENISE CHARLESTOWN MA 02129 02/26/2016 1000.00 STOP LOSS INSURANCE BROKERS 201604129012296990

DOYLE, DENISE CHARLESTOWN MA 02129 10/24/2014 500.00 STOP LOSS INSURANCE BROKERS 15950029441

DOYLE, DENISE BOSTON MA 02116 04/06/2012 250.00 STOP LOSS INSURANCE BROKERS 12952264044

DOYLE, DENISE CHARLESTOWN MA 02129 09/10/2018 500.00 STOP LOSS INSURANCE BROKERS 201810239130757883

DOYLE, DENISE CHARLESTOWN MA 02129 04/24/2017 2000.00 STOP LOSS INSURANCE BROKERS 201805099112002205

DRELICH, DONALD STAMFORD CT 06902 09/19/2018 1000.00 D.W. VAN DYKE & CO., INC 201810239130757883

DRELICH, DONALD STAMFORD CT 06902 10/06/2011 500.00 D.W. VAN DYKE & CO., INC 12970139404

DRELICH, DONALD STAMFORD CT 06902 10/08/2012 1000.00 D.W. VAN DYKE & CO., INC 13940103796

DRELICH, DONALD STAMFORD CT 06902 07/28/2015 1000.00 D.W. VAN DYKE & CO., INC 201601219004554637

DRELICH, DONALD STAMFORD CT 06902 05/16/2016 1000.00 D.W. VAN DYKE & CO., INC 201607129020413635

DRELICH, DONALD STAMFORD CT 06902 03/02/2017 1000.00 D.W. VAN DYKE & CO., INC 201805099112002205

DRELICH, DONALD STAMFORD CT 06902 05/02/2017 250.00 D.W. VAN DYKE & CO., INC 201805099112002205

DRELICH, DONALD STAMFORD CT 06902 06/22/2017 450.00 D.W. VAN DYKE & CO., INC 201805099112002206

DRISCOLL, DANA HELOTES TX 78023 11/17/2016 125.00 NATIONAL UNDERWRITING SERVICES 201707069066531429

DRISCOLL, DANA HELOTES TX 78023 08/17/2016 125.00 NATIONAL UNDERWRITING SERVICES 201707069066531398

DUGAN, DANIEL NASHVILLE TN 37210 06/23/2016 2500.00 NORTH AMERICA ADMINISTRATORS 201607129020413635

DUGAN, DANIEL NASHVILLE TN 37210 02/26/2016 1000.00 NORTH AMERICA ADMINISTRATORS 201604129012296991

EASTLAND, SCOTT DANVERS MA 01923 10/27/2014 500.00 ARAN INSURANCE UNDERWRITERS 15950029441

EDDY, PARK EWART LAGUNA HILLS CA 92653 03/15/2016 1000.00 ACTIVE CAPTIVE MANAGEMENT 201604129012296991

EDDY, PARK EWART LAGUNA HILLS CA 92653 04/02/2018 1000.00 ACTIVE CAPTIVE MANAGEMENT 201808279121530793

EDDY, PARK EWART LAGUNA HILLS CA 92653 04/18/2017 500.00 ACTIVE CAPTIVE MANAGEMENT 201805099112002206

EDWARDS, JOE LITTLE ROCK AR 72223 01/31/2013 1000.00 HEALTHSCOPE BENEFITS 13964043856

EGAN, KEVIN NORTH ANDOVER MA 01845 06/01/2017 450.00 CORPORATE BENEFIT AUDITS, INC. 201805099112002206

EGAN, KEVIN NORTH ANDOVER MA 01845 09/12/2018 250.00 CORPORATE BENEFIT AUDITS, INC. 201810239130757884

ELDRIDGE, RICK GREENWOOD VILLAGE CO 80111 08/04/2016 1000.00 THE INTUITIVE COMPANIES 201707069066531398

FARLEY, JAMES WESTLAKE OH 44145 10/19/2011 200.00 THE J.P. FARLEY CORPORATION 12970139404

FARLEY, JAMES WESTLAKE OH 44145 05/04/2011 300.00 THE J.P. FARLEY CORPORATION 12950220093

FEAR, SR. ROSEVILLE CA 95661 01/11/2018 300.00 SHEPLER & FEAR GENERAL AGENCY 201805099112002380

FEAR, SR. ROSEVILLE CA 95661 04/06/2017 250.00 SHEPLER & FEAR GENERAL AGENCY 201805099112002207

FENTERS, SANDRA PITTSBURG PA 15219 05/01/2017 1100.00 CAPTERRA RISK 201805099112002207

FERRERA, TESS WASHINGTON DC 20001 09/16/2015 500.00 LAW 201601219004554637

FLEDER, RICHARD NEW YORK NY 10016 02/07/2018 2000.00 ELMC HOLDINGS 201805099112002381

FLEDER, RICHARD NEW YORK NY 10016 05/05/2016 1000.00 ELMC HOLDINGS 201607129020413636

FLOWERS, VAL MARIETTA GA 30066 03/01/2017 500.00 CREATIVE RISK UNDERWRITERS 201805099112002207

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WILLIAMS, SCOTT E. BRENTWOOD TN 37027 06/22/2016 500.00 GOLDEN TRIANGLE SPECIALTY NETW 201607129020413658

WILNEFF, MITCHELL GLENCOE IL 60022 10/19/2011 500.00 ALLIED BENEFIT SYSTEMS, INC. 12970139418

WILNEFF, MITCHELL GLENCOE IL 60022 03/15/2016 1000.00 ALLIED BENEFIT SYSTEMS, INC. 201604129012296996

WILNEFF, MITCHELL GLENCOE IL 60022 06/04/2012 2500.00 ALLIED BENEFIT SYSTEMS, INC. 12952264049

WILNEFF, MITCHELL GLENCOE IL 60022 04/20/2010 1000.00 ALLIED BENEFIT SYSTEMS, INC. 10990831870

WILSON, DAVID PRINCETON JUNCTION NJ 08550 03/17/2017 1250.00 WINDSOR STRATEGY PARTNERS 201805099112002239

WILSON, DAVID PRINCETON JUNCTION NJ 08550 04/11/2018 1000.00 WINDSOR STRATEGY PARTNERS 201808279121530800

WILSON, DAVID PRINCETON JUNCTION NJ 08550 03/02/2018 500.00 WINDSOR STRATEGY PARTNERS 201805099112002391

WILSON, DAVID PRINCETON JUNCTION NJ 08550 05/16/2016 1000.00 WINDSOR STRATEGY PARTNERS 201607129020413658

WOLAK, DANIEL TRUMBULL CT 06611 02/04/2013 1000.00 UNION LABOR LIFE INSURANCE CO. 13964043865

WOLAK, DANIEL SILVER SPRING MD 20910 10/07/2014 1000.00 UNION LABOR LIFE INSURANCE CO. 15970013833

WOLAK, DANIEL SILVER SPRING MD 20910 08/24/2015 1000.00 UNION LABOR LIFE INSURANCE CO. 201601219004554643

WOLAK, DANIEL TRUMBULL CT 06611 10/08/2012 500.00 UNION LABOR LIFE INSURANCE CO. 13940103799

WOLF, CONNIE OKLAHOMA CITY OK 73172 09/13/2018 250.00 MCM SOLUTIONS FOR BETTER HEALT 201810239130757890

YOUNG, GERALD WASHINGTON DC 20015 03/30/2010 250.00 SPECIALTY CARE MANAGEMENT 10930617164

YOUNG, M DAVID MARETTA GA 30062 04/06/2012 1000.00 YOUNG CONSULTING 12952264050

YOUNG, M DAVID MARETTA GA 30062 05/08/2018 1000.00 YOUNG CONSULTING 201808279121530800

YOUNGS, JASON ELK GROVE CA 95757 02/01/2013 250.00 ONE SOURCE STOP LOSS 13964043866

YOUNGS, JASON ELK GROVE CA 95757 05/26/2016 1000.00 ONE SOURCE STOP LOSS 201607129020413658

YOUNGS, JOHN ELK GROVE CA 95757 11/29/2016 100.00 ONESOURCE STOP LOSS 201707069066531443

YOUNGS, JOHN ELK GROVE CA 95757 12/30/2016 100.00 ONESOURCE STOP LOSS 201707069066531443

YOUNGS, JOHN ELK GROVE CA 95757 07/29/2016 100.00 ONESOURCE STOP LOSS 201707069066531401

YOUNGS, JOHN ELK GROVE CA 95757 03/30/2010 1000.00 ONESOURCE STOP LOSS 10930617165

YOUNGS, JOHN ELK GROVE CA 95757 10/26/2016 100.00 ONESOURCE STOP LOSS 201707069066531429

YOUNGS, JOHN ELK GROVE CA 95757 09/29/2016 100.00 ONESOURCE STOP LOSS 201707069066531402

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YOUNGS, JOHN ELK GROVE CA 95757 08/20/2012 2090.00 ONESOURCE STOP LOSS 13940103779

YOUNGS, JOHN ELK GROVE CA 95757 03/27/2017 100.00 ONESOURCE STOP LOSS 201805099112002239

ZIOMEK, BOB MINNESTRISTA MN 55364 09/24/2012 1000.00 AXIA STRATEGIES 13940103780

CONTRIBUTION REFUND TO AN INDIVIDUAL

BECK, JARID LONG BEACH CA 90802 01/27/2018 -500.00 201805099112002407

BORANS, PETER LYNNFIELD MA 01940 03/14/2016 -1000.00 201604129012297002

BYRD, TOM DULUTH GA 30097 01/18/2017 -500.00 201805099112002263

DRISCOLL, DANA HELOTES TX 78023 05/18/2016 -375.00 201607129020413674

HOATH, ART TAMPA FL 33602 02/17/2017 -1500.00 201805099112002263

LANZA, MICHAEL KENNESAW GA 30144 05/05/2016 -750.00 201607129020413674

LAWRENZ, DONALD R. CORONA DEL MAR CA 92625 09/16/2011 -500.00 12970139426

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