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Compensation Disclosure <br />Compensation Disclosure —Attachment Sheet 4 of 5 Sheet(s) <br />Lockton believes it is or may be entitled to receive the compensation listed below, from the insurance companies and/or other entities <br />listed below, attributable to the insurance and/or administrative service contracts placed with those insurers and/or other entities on <br />your behalf. <br />Client Name: <br />INDIAN RIVER COUNTY <br />Insurer or TPA: <br />Mutual of Omaha Insurance Company <br />Policy or Benefit Type: <br />Worksite Benefits <br />Plan Name: <br />Accident, Critical Illness <br />Policy / Contract Year: <br />Effective Date 10/1/2022 to Expiration Date 9/30/2024 <br />Base Commissions: <br />Rate - Net of commission <br />Additional <br />This insurer/TPA does have an Additional Compensation program in place that might apply to the placement of your <br />Compensation: <br />policy(ies) or administrative -services -only contract(s). Upon request, Lockton can provide you with a more detailed <br />description of the manner in which the Additional Compensation that Lockton may receive under such program would be <br />calculated. <br />Client Name: <br />Insurer or TPA: <br />Policy or Benefit Type: <br />Plan Name: <br />Policy / Contract Year: <br />Base Commissions: <br />Additional <br />Compensation: <br />Client Name: <br />Insurer or TPA: <br />Policy or Benefit Type: <br />Plan Name: <br />Policy / Contract Year: <br />Base Commissions: <br />Additional <br />Compensation: <br />Client Name: <br />Insurer or TPA: <br />Policy or Benefit Type: <br />Plan Name: <br />Policy / Contract Year: <br />Base Commissions: <br />Additional <br />Compensation: <br />INDIAN RIVER COUNTY <br />P&A Group, Inc. <br />FSA Admin <br />FSA Admin <br />Effective Date 10/1/2021 to Expiration Date 9/30/2026 <br />$0.00 per Month <br />This insurer/TPA does not have an Additional Compensation program in place that might apply to the placement of your <br />policy(ies) or administrative -services -only contract(s). <br />INDIAN RIVER COUNTY <br />P&A Group, Inc. <br />COBRA Administration <br />COBRA Administration <br />Effective Date 10/1/2021 to Expiration Date 9/30/2024 <br />$0.00 per Month <br />This insurer/TPA does not have an Additional Compensation program in place that might apply to the placement of your <br />policy(ies) or administrative -services -only contract(s). <br />INDIAN RIVER COUNTY <br />Lockton (TPA) <br />Fee for Service - Consulting/Project <br />Consulting Fee <br />Effective Date 10/1/2022 to Expiration Date 9/30/2027 <br />$22,500.00 per Quarter <br />This insurer/TPA does not have an Additional Compensation program in place that might apply to the placement of your <br />policy(ies) or administrative -services -only contract(s). <br />Copyright 2022 Lockton Companies, LLC. All rights reserved. The contents of this document are proprietary and confidential. <br />Unauthorized duplication of this document is prohibited. <br />=BTW Page 14 of 15 <br />