401k Plan data: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN plan

FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 401k Plan overview

Plan Name	FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN
Plan identification number	504

FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

FIRST NATIONAL BANK AND TRUST COMPANY has sponsored the creation of one or more 401k plans.

Company Name: FIRST NATIONAL BANK AND TRUST COMPANY

Employer identification number (EIN): 730130930

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01 CLAYTON LODES 2023-08-11
504 2021-01-01 CLAYTON LODES 2022-06-30
504 2020-01-01 CLAYTON LODES 2021-08-09
504 2019-01-01
504 2018-01-01 CLAYTON LODES
504 2017-01-01 CURTIS DAVIDSON
504 2016-01-01 CURTIS DAVIDSON
504 2015-01-01 CURTIS DAVIDSON
504 2014-01-01 CURTIS DAVIDSON
504 2013-01-01 CURTIS DAVIDSON
504 2012-01-01 VICKY TYLER
504 2011-01-01 CURTIS DAVIDSON
504 2010-01-01 CURTIS DAVIDSON
504 2009-01-01 CURTIS DAVIDSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
504	2022-01-01	CLAYTON LODES	2023-08-11
504	2021-01-01	CLAYTON LODES	2022-06-30
504	2020-01-01	CLAYTON LODES	2021-08-09
504	2019-01-01
504	2018-01-01	CLAYTON LODES
504	2017-01-01	CURTIS DAVIDSON
504	2016-01-01	CURTIS DAVIDSON
504	2015-01-01	CURTIS DAVIDSON
504	2014-01-01	CURTIS DAVIDSON
504	2013-01-01	CURTIS DAVIDSON
504	2012-01-01	VICKY TYLER
504	2011-01-01	CURTIS DAVIDSON
504	2010-01-01	CURTIS DAVIDSON
504	2009-01-01	CURTIS DAVIDSON

Plan Statistics for FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN

401k plan membership statisitcs for FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN

Measure Date Value
2022: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 157
Total of all active and inactive participants 2022-01-01 157
Total participants 2022-01-01 157
2021: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 156
Total of all active and inactive participants 2021-01-01 156
Total participants 2021-01-01 156
2020: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 152
Total of all active and inactive participants 2020-01-01 152
Total participants 2020-01-01 152
2019: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 147
Total of all active and inactive participants 2019-01-01 147
Total participants 2019-01-01 147
2018: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 135
Total of all active and inactive participants 2018-01-01 135
Total participants 2018-01-01 135
2017: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 133
Total of all active and inactive participants 2017-01-01 133
Total participants 2017-01-01 133
2016: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 127
Total of all active and inactive participants 2016-01-01 127
Total participants 2016-01-01 127
2015: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 127
Total of all active and inactive participants 2015-01-01 127
Total participants 2015-01-01 127
2014: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 124
Total of all active and inactive participants 2014-01-01 124
Total participants 2014-01-01 124
2013: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 126
Total of all active and inactive participants 2013-01-01 126
Total participants 2013-01-01 126
2012: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 127
Total of all active and inactive participants 2012-01-01 127
Total participants 2012-01-01 127
2011: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 123
Total of all active and inactive participants 2011-01-01 123
Total participants 2011-01-01 123
2010: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 124
Total of all active and inactive participants 2010-01-01 124
Total participants 2010-01-01 124
2009: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 134
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 0
Total of all active and inactive participants 2009-01-01 134

Measure	Date	Value
2022: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	157
Total of all active and inactive participants	2022-01-01	157
Total participants	2022-01-01	157
2021: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	156
Total of all active and inactive participants	2021-01-01	156
Total participants	2021-01-01	156
2020: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	152
Total of all active and inactive participants	2020-01-01	152
Total participants	2020-01-01	152
2019: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	147
Total of all active and inactive participants	2019-01-01	147
Total participants	2019-01-01	147
2018: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	135
Total of all active and inactive participants	2018-01-01	135
Total participants	2018-01-01	135
2017: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	133
Total of all active and inactive participants	2017-01-01	133
Total participants	2017-01-01	133
2016: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	127
Total of all active and inactive participants	2016-01-01	127
Total participants	2016-01-01	127
2015: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	127
Total of all active and inactive participants	2015-01-01	127
Total participants	2015-01-01	127
2014: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	124
Total of all active and inactive participants	2014-01-01	124
Total participants	2014-01-01	124
2013: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	126
Total of all active and inactive participants	2013-01-01	126
Total participants	2013-01-01	126
2012: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	127
Total of all active and inactive participants	2012-01-01	127
Total participants	2012-01-01	127
2011: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	123
Total of all active and inactive participants	2011-01-01	123
Total participants	2011-01-01	123
2010: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	124
Total of all active and inactive participants	2010-01-01	124
Total participants	2010-01-01	124
2009: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	134
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	0
Total of all active and inactive participants	2009-01-01	134

Form 5500 Responses for FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN

2022: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2018: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2017: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2016: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2015: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2014: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2013: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2012: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2011: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2010: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes
2009: FIRST NATIONAL BANK OF ARDMORE LIFE AND LTD PLAN 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	89
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,283
Total amount of fees paid to insurance company	USD $1,396
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $35,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,283
Amount paid for insurance broker fees	1396
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	97
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,616
Total amount of fees paid to insurance company	USD $962
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $24,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,616
Amount paid for insurance broker fees	962
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	157
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,815
Total amount of fees paid to insurance company	USD $976
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,815
Amount paid for insurance broker fees	976
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	157
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,986
Total amount of fees paid to insurance company	USD $549
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,986
Amount paid for insurance broker fees	549
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	156
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,977
Total amount of fees paid to insurance company	USD $708
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,977
Amount paid for insurance broker fees	708
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	156
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,535
Total amount of fees paid to insurance company	USD $1,052
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,535
Amount paid for insurance broker fees	1052
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	101
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,506
Total amount of fees paid to insurance company	USD $959
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,506
Amount paid for insurance broker fees	959
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	71
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,045
Total amount of fees paid to insurance company	USD $1,835
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $33,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,045
Amount paid for insurance broker fees	1835
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	152
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,941
Total amount of fees paid to insurance company	USD $510
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,941
Amount paid for insurance broker fees	510
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	152
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,886
Total amount of fees paid to insurance company	USD $755
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,886
Amount paid for insurance broker fees	755
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	95
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,614
Total amount of fees paid to insurance company	USD $671
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $17,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,614
Amount paid for insurance broker fees	671
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	67
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,074
Total amount of fees paid to insurance company	USD $1,255
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $33,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,074
Amount paid for insurance broker fees	1255
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	67
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,361
Total amount of fees paid to insurance company	USD $583
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $29,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,361
Amount paid for insurance broker fees	583
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	90
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,374
Total amount of fees paid to insurance company	USD $365
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $15,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,374
Amount paid for insurance broker fees	365
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,669
Total amount of fees paid to insurance company	USD $366
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,669
Amount paid for insurance broker fees	366
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	147
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,801
Total amount of fees paid to insurance company	USD $246
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $12,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,801
Amount paid for insurance broker fees	246
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	56
Insurance policy start date	2018-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,108
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $27,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,108
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	86
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,565
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $17,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,565
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	135
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,573
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,573
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	135
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,726
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,726
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	133
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,700
Total amount of fees paid to insurance company	USD $552
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,700
Amount paid for insurance broker fees	552
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CROSS POINTS INS ADVISORS LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	133
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,567
Total amount of fees paid to insurance company	USD $837
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,567
Amount paid for insurance broker fees	837
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CROSS POINT INS ADVISORS LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ANJR

Policy instance

Insurance contract or identification number	GUC 0ANJR
Number of Individuals Covered	91
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,635
Total amount of fees paid to insurance company	USD $860
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $17,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,635
Amount paid for insurance broker fees	860
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CROSS POINT INS ADVISORS LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ANJR

Policy instance

Insurance contract or identification number	GVTL0ANJR
Number of Individuals Covered	59
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,973
Total amount of fees paid to insurance company	USD $1,254
Other welfare benefits provided	LIFE & AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $26,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,973
Amount paid for insurance broker fees	1254
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CROSS POINT INS ADVISORS LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	127
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,994
Total amount of fees paid to insurance company	USD $1,547
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,994
Amount paid for insurance broker fees	1547
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	127
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,254
Total amount of fees paid to insurance company	USD $1,040
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,254
Amount paid for insurance broker fees	1040
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	124
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,913
Total amount of fees paid to insurance company	USD $740
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,913
Amount paid for insurance broker fees	740
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	124
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,303
Total amount of fees paid to insurance company	USD $490
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,303
Amount paid for insurance broker fees	490
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ANJR

Policy instance

Insurance contract or identification number	GLUG0ANJR
Number of Individuals Covered	126
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,673
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,673
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ANJR

Policy instance

Insurance contract or identification number	GLTD0ANJR
Number of Individuals Covered	126
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,490
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,490
Insurance broker organization code?	3
Insurance broker name	THE BRAMLETT AGENCY INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

119838

Policy instance

Insurance contract or identification number	119838
Number of Individuals Covered	127
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,056
Total amount of fees paid to insurance company	USD $179
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,056
Insurance broker organization code?	3
Amount paid for insurance broker fees	179
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker name	BAINS/WEST BENEFITS INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

119838

Policy instance

Insurance contract or identification number	119838
Number of Individuals Covered	123
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,631
Total amount of fees paid to insurance company	USD $216
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

119838

Policy instance

Insurance contract or identification number	119838
Number of Individuals Covered	124
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,606
Total amount of fees paid to insurance company	USD $214
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FIRST NATIONAL BANK AND TRUST COMPANY
Employer identification number (EIN):	730130930
NAIC Classification:	522110
NAIC Description:	Commercial Banking