FIRST STATE BANK & TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FIRST STATE BANK & TRUST P/S & 401(K)
| Measure | Date | Value |
|---|
| 2019: FIRST STATE BANK & TRUST P/S & 401(K) 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 76 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 59 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 18 |
| Total of all active and inactive participants | 2019-01-01 | 77 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 77 |
| Number of participants with account balances | 2019-01-01 | 77 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 1 |
| 2018: FIRST STATE BANK & TRUST P/S & 401(K) 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 70 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 53 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 12 |
| Total of all active and inactive participants | 2018-01-01 | 65 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 65 |
| Number of participants with account balances | 2018-01-01 | 65 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 2 |
| 2017: FIRST STATE BANK & TRUST P/S & 401(K) 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 59 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 7 |
| Total of all active and inactive participants | 2017-01-01 | 66 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 66 |
| Number of participants with account balances | 2017-01-01 | 65 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 1 |
| 2016: FIRST STATE BANK & TRUST P/S & 401(K) 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 59 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 5 |
| Total of all active and inactive participants | 2016-01-01 | 64 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 64 |
| Number of participants with account balances | 2016-01-01 | 60 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 1 |
| 2015: FIRST STATE BANK & TRUST P/S & 401(K) 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 61 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 47 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 8 |
| Total of all active and inactive participants | 2015-01-01 | 55 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 55 |
| Number of participants with account balances | 2015-01-01 | 54 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 2 |
| 2014: FIRST STATE BANK & TRUST P/S & 401(K) 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 50 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 8 |
| Total of all active and inactive participants | 2014-01-01 | 58 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 58 |
| Number of participants with account balances | 2014-01-01 | 58 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: FIRST STATE BANK & TRUST P/S & 401(K) 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 44 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 5 |
| Total of all active and inactive participants | 2013-01-01 | 49 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 49 |
| Number of participants with account balances | 2013-01-01 | 48 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: FIRST STATE BANK & TRUST P/S & 401(K) 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 40 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 10 |
| Total of all active and inactive participants | 2012-01-01 | 50 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 50 |
| Number of participants with account balances | 2012-01-01 | 50 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: FIRST STATE BANK & TRUST P/S & 401(K) 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 52 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 44 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 5 |
| Total of all active and inactive participants | 2011-01-01 | 49 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 49 |
| Number of participants with account balances | 2011-01-01 | 48 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: FIRST STATE BANK & TRUST P/S & 401(K) 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 53 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 48 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 4 |
| Total of all active and inactive participants | 2010-01-01 | 52 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 52 |
| Number of participants with account balances | 2010-01-01 | 51 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: FIRST STATE BANK & TRUST P/S & 401(K) 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 44 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 2 |
| Total of all active and inactive participants | 2009-01-01 | 46 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 46 |
| Number of participants with account balances | 2009-01-01 | 46 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2019 : FIRST STATE BANK & TRUST P/S & 401(K) 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $43 |
| Total income from all sources | 2019-12-31 | $1,411,343 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $84,815 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $83,710 |
| Total plan assets at end of year | 2019-12-31 | $5,255,434 |
| Total plan assets at beginning of year | 2019-12-31 | $3,928,863 |
| Value of fidelity bond covering the plan | 2019-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $215,487 |
| Other income received | 2019-12-31 | $1,067,069 |
| Net income (gross income less expenses) | 2019-12-31 | $1,326,528 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $5,255,391 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $3,928,863 |
| Assets. Value of participant loans | 2019-12-31 | $20,576 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $128,787 |
| Value of corrective distributions | 2019-12-31 | $43 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $1,062 |
| 2018 : FIRST STATE BANK & TRUST P/S & 401(K) 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $49,508 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $967,049 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $966,219 |
| Total plan assets at end of year | 2018-12-31 | $3,928,863 |
| Total plan assets at beginning of year | 2018-12-31 | $4,846,404 |
| Value of fidelity bond covering the plan | 2018-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $181,087 |
| Other income received | 2018-12-31 | $-245,909 |
| Net income (gross income less expenses) | 2018-12-31 | $-917,541 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $3,928,863 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $4,846,404 |
| Assets. Value of participant loans | 2018-12-31 | $22,193 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $114,330 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $830 |
| 2017 : FIRST STATE BANK & TRUST P/S & 401(K) 2017 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2017-12-31 | $1,915 |
| Total income from all sources | 2017-12-31 | $1,007,834 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $73,427 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $73,003 |
| Total plan assets at end of year | 2017-12-31 | $4,846,404 |
| Total plan assets at beginning of year | 2017-12-31 | $3,913,912 |
| Value of fidelity bond covering the plan | 2017-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $180,086 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $3,346 |
| Other income received | 2017-12-31 | $699,319 |
| Net income (gross income less expenses) | 2017-12-31 | $934,407 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $4,846,404 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $3,911,997 |
| Assets. Value of participant loans | 2017-12-31 | $17,029 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $125,083 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $424 |
| 2016 : FIRST STATE BANK & TRUST P/S & 401(K) 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $1,915 |
| Total plan liabilities at beginning of year | 2016-12-31 | $2,466 |
| Total income from all sources | 2016-12-31 | $567,202 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $66,891 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $64,617 |
| Total plan assets at end of year | 2016-12-31 | $3,913,912 |
| Total plan assets at beginning of year | 2016-12-31 | $3,414,152 |
| Value of fidelity bond covering the plan | 2016-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $183,514 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $3,041 |
| Other income received | 2016-12-31 | $258,611 |
| Net income (gross income less expenses) | 2016-12-31 | $500,311 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $3,911,997 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $3,411,686 |
| Assets. Value of participant loans | 2016-12-31 | $8,795 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $122,036 |
| Value of corrective distributions | 2016-12-31 | $1,915 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $359 |
| 2015 : FIRST STATE BANK & TRUST P/S & 401(K) 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $2,466 |
| Total plan liabilities at beginning of year | 2015-12-31 | $357 |
| Total income from all sources | 2015-12-31 | $282,301 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $526,850 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $523,671 |
| Total plan assets at end of year | 2015-12-31 | $3,414,152 |
| Total plan assets at beginning of year | 2015-12-31 | $3,656,592 |
| Value of fidelity bond covering the plan | 2015-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $196,956 |
| Contributions received from other sources (not participants or employers) | 2015-12-31 | $12,223 |
| Other income received | 2015-12-31 | $-40,441 |
| Net income (gross income less expenses) | 2015-12-31 | $-244,549 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $3,411,686 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $3,656,235 |
| Assets. Value of participant loans | 2015-12-31 | $11,362 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $113,563 |
| Value of corrective distributions | 2015-12-31 | $2,466 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $713 |
| 2014 : FIRST STATE BANK & TRUST P/S & 401(K) 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $357 |
| Total income from all sources | 2014-12-31 | $456,852 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $550,711 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $550,183 |
| Total plan assets at end of year | 2014-12-31 | $3,656,592 |
| Total plan assets at beginning of year | 2014-12-31 | $3,750,094 |
| Value of fidelity bond covering the plan | 2014-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $171,015 |
| Other income received | 2014-12-31 | $179,142 |
| Net income (gross income less expenses) | 2014-12-31 | $-93,859 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $3,656,235 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $3,750,094 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $106,695 |
| Value of corrective distributions | 2014-12-31 | $357 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $171 |
| 2013 : FIRST STATE BANK & TRUST P/S & 401(K) 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $763,407 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $314,849 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $314,417 |
| Total plan assets at end of year | 2013-12-31 | $3,750,094 |
| Total plan assets at beginning of year | 2013-12-31 | $3,301,536 |
| Value of fidelity bond covering the plan | 2013-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $133,287 |
| Other income received | 2013-12-31 | $540,475 |
| Net income (gross income less expenses) | 2013-12-31 | $448,558 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $3,750,094 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $3,301,536 |
| Assets. Value of participant loans | 2013-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $89,645 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $432 |
| 2012 : FIRST STATE BANK & TRUST P/S & 401(K) 2012 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2012-12-31 | $1,020 |
| Total income from all sources | 2012-12-31 | $587,626 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $589,589 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $589,232 |
| Total plan assets at end of year | 2012-12-31 | $3,301,536 |
| Total plan assets at beginning of year | 2012-12-31 | $3,304,519 |
| Value of fidelity bond covering the plan | 2012-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $142,346 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $2,049 |
| Other income received | 2012-12-31 | $386,648 |
| Net income (gross income less expenses) | 2012-12-31 | $-1,963 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $3,301,536 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $3,303,499 |
| Assets. Value of participant loans | 2012-12-31 | $3,743 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $56,583 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $357 |
| 2011 : FIRST STATE BANK & TRUST P/S & 401(K) 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $1,020 |
| Total plan liabilities at beginning of year | 2011-12-31 | $2,245 |
| Total income from all sources | 2011-12-31 | $98,623 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $284,122 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $282,222 |
| Total plan assets at end of year | 2011-12-31 | $3,304,519 |
| Total plan assets at beginning of year | 2011-12-31 | $3,491,243 |
| Value of fidelity bond covering the plan | 2011-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $156,213 |
| Other income received | 2011-12-31 | $-57,590 |
| Net income (gross income less expenses) | 2011-12-31 | $-185,499 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $3,303,499 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $3,488,998 |
| Assets. Value of participant loans | 2011-12-31 | $8,654 |
| Value of corrective distributions | 2011-12-31 | $1,020 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $880 |
| 2010 : FIRST STATE BANK & TRUST P/S & 401(K) 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $2,245 |
| Total income from all sources | 2010-12-31 | $631,458 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $51,802 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $49,147 |
| Total plan assets at end of year | 2010-12-31 | $3,491,243 |
| Total plan assets at beginning of year | 2010-12-31 | $2,909,342 |
| Value of fidelity bond covering the plan | 2010-12-31 | $2,800,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $159,187 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $30,000 |
| Other income received | 2010-12-31 | $442,271 |
| Net income (gross income less expenses) | 2010-12-31 | $579,656 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $3,488,998 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,909,342 |
| Assets. Value of participant loans | 2010-12-31 | $16,753 |
| Value of corrective distributions | 2010-12-31 | $2,245 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $410 |
| 2019: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: FIRST STATE BANK & TRUST P/S & 401(K) 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: FIRST STATE BANK & TRUST P/S & 401(K) 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: FIRST STATE BANK & TRUST P/S & 401(K) 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 funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: FIRST STATE BANK & TRUST P/S & 401(K) 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $3 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 | | Amount paid for insurance broker fees | 3 | | Insurance broker organization code? | 3 |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012914624 |
| Policy instance | 3 |
| Insurance contract or identification number | 1012914624 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $793 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $793 | | Insurance broker organization code? | 3 |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012562663 |
| Policy instance | 2 |
| Insurance contract or identification number | 1012562663 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,090 | | Insurance broker organization code? | 3 |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $214 | | Total amount of fees paid to insurance company | USD $3 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $214 | | Amount paid for insurance broker fees | 3 | | Insurance broker organization code? | 3 |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $305 | | Total amount of fees paid to insurance company | USD $7 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $305 | | Amount paid for insurance broker fees | 7 | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012562663 |
| Policy instance | 2 |
| Insurance contract or identification number | 1012562663 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012914624 |
| Policy instance | 3 |
| Insurance contract or identification number | 1012914624 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012914624 |
| Policy instance | 4 |
| Insurance contract or identification number | 1012914624 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012562663 |
| Policy instance | 3 |
| Insurance contract or identification number | 1012562663 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $675 | | Total amount of fees paid to insurance company | USD $132 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $675 | | Amount paid for insurance broker fees | 132 | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $372 | | Total amount of fees paid to insurance company | USD $18 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $372 | | Amount paid for insurance broker fees | 18 | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08010173 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08010173 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 3 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,681 | | Total amount of fees paid to insurance company | USD $89 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,681 | | Amount paid for insurance broker fees | 89 | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012562663 |
| Policy instance | 4 |
| Insurance contract or identification number | 1012562663 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012914624 |
| Policy instance | 5 |
| Insurance contract or identification number | 1012914624 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $371 | | Total amount of fees paid to insurance company | USD $12 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $371 | | Amount paid for insurance broker fees | 12 | | Insurance broker organization code? | 3 | | Insurance broker name | SECURITIES AMERICA INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $340 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $340 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 3 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,531 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,531 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012562663 |
| Policy instance | 4 |
| Insurance contract or identification number | 1012562663 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SII INVESTMENTS INC |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | 1012914624 |
| Policy instance | 5 |
| Insurance contract or identification number | 1012914624 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,900 | | Insurance broker organization code? | 3 | | Insurance broker name | SII INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08010173 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08010173 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,395 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,395 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08010173 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08010173 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,939 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,939 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 3 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,315 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,315 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR09003780 |
| Policy instance | 4 |
| Insurance contract or identification number | VR09003780 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,482 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,482 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | 1012562663 |
| Policy instance | 5 |
| Insurance contract or identification number | 1012562663 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-12-17 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $29,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,750 | | Insurance broker organization code? | 3 | | Insurance broker name | SII INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $306 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $306 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 3 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,271 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR09003780 |
| Policy instance | 4 |
| Insurance contract or identification number | VR09003780 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,482 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08010173 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08010173 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,957 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $296 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08005628 |
| Policy instance | 3 |
| Insurance contract or identification number | VR08005628 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,013 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,013 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08010173 |
| Policy instance | 2 |
| Insurance contract or identification number | VR08010173 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,578 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,578 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR08011634 |
| Policy instance | 1 |
| Insurance contract or identification number | VR08011634 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $268 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $268 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | VR09003780 |
| Policy instance | 4 |
| Insurance contract or identification number | VR09003780 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,070 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,070 | | Insurance broker organization code? | 3 | | Insurance broker name | S I I INVESTMENTS INC |
|
