FIRST COMMUNITY BANK has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FIRST COMMUNITY BANK CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2023 : FIRST COMMUNITY BANK CAFETERIA PLAN 2023 401k financial data |
|---|
| Value of fidelity bond covering the plan | 2023-12-31 | $5,000,000 |
| 2022 : FIRST COMMUNITY BANK CAFETERIA PLAN 2022 401k financial data |
|---|
| Value of fidelity bond covering the plan | 2022-12-31 | $5,000,000 |
| 2015 : FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-08-31 | $1,774,845 |
| Expenses. Total of all expenses incurred | 2015-08-31 | $1,774,845 |
| Benefits paid (including direct rollovers) | 2015-08-31 | $1,499,621 |
| Total contributions received or receivable from participants | 2015-08-31 | $777,177 |
| Total contributions received or receivable from employer(s) | 2015-08-31 | $997,668 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-08-31 | $275,224 |
| 2014 : FIRST COMMUNITY BANK CAFETERIA PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-08-31 | $1,314,207 |
| Expenses. Total of all expenses incurred | 2014-08-31 | $1,226,618 |
| Benefits paid (including direct rollovers) | 2014-08-31 | $1,018,419 |
| Total contributions received or receivable from participants | 2014-08-31 | $532,223 |
| Expenses. Other expenses not covered elsewhere | 2014-08-31 | $31,110 |
| Net income (gross income less expenses) | 2014-08-31 | $87,589 |
| Total contributions received or receivable from employer(s) | 2014-08-31 | $781,984 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-08-31 | $177,089 |
| 2013 : FIRST COMMUNITY BANK CAFETERIA PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-08-31 | $112,713 |
| Expenses. Total of all expenses incurred | 2013-08-31 | $112,713 |
| Benefits paid (including direct rollovers) | 2013-08-31 | $96,952 |
| Total contributions received or receivable from participants | 2013-08-31 | $63,567 |
| Total contributions received or receivable from employer(s) | 2013-08-31 | $49,146 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-08-31 | $15,761 |
| 2012 : FIRST COMMUNITY BANK CAFETERIA PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-08-31 | $0 |
| Total plan liabilities at beginning of year | 2012-08-31 | $0 |
| Total income from all sources | 2012-08-31 | $334,048 |
| Expenses. Total of all expenses incurred | 2012-08-31 | $334,048 |
| Benefits paid (including direct rollovers) | 2012-08-31 | $294,076 |
| Total plan assets at end of year | 2012-08-31 | $0 |
| Total plan assets at beginning of year | 2012-08-31 | $0 |
| Total contributions received or receivable from participants | 2012-08-31 | $142,822 |
| Total contributions received or receivable from employer(s) | 2012-08-31 | $191,226 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-08-31 | $39,972 |
| 2011 : FIRST COMMUNITY BANK CAFETERIA PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-08-31 | $0 |
| Total plan liabilities at beginning of year | 2011-08-31 | $0 |
| Total income from all sources | 2011-08-31 | $1,003,325 |
| Expenses. Total of all expenses incurred | 2011-08-31 | $1,003,325 |
| Benefits paid (including direct rollovers) | 2011-08-31 | $865,045 |
| Total plan assets at end of year | 2011-08-31 | $0 |
| Total plan assets at beginning of year | 2011-08-31 | $0 |
| Total contributions received or receivable from participants | 2011-08-31 | $409,860 |
| Total contributions received or receivable from employer(s) | 2011-08-31 | $593,465 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-08-31 | $138,280 |
| 2010 : FIRST COMMUNITY BANK CAFETERIA PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-08-31 | $0 |
| Total plan liabilities at beginning of year | 2010-08-31 | $0 |
| Total income from all sources | 2010-08-31 | $893,143 |
| Expenses. Total of all expenses incurred | 2010-08-31 | $893,143 |
| Benefits paid (including direct rollovers) | 2010-08-31 | $752,196 |
| Total plan assets at end of year | 2010-08-31 | $0 |
| Total plan assets at beginning of year | 2010-08-31 | $0 |
| Total contributions received or receivable from participants | 2010-08-31 | $367,164 |
| Total contributions received or receivable from employer(s) | 2010-08-31 | $525,979 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-08-31 | $140,947 |
| 2009 : FIRST COMMUNITY BANK CAFETERIA PLAN 2009 401k financial data |
|---|
| Total plan liabilities at end of year | 2009-08-31 | $0 |
| Total plan liabilities at beginning of year | 2009-08-31 | $0 |
| Total income from all sources | 2009-08-31 | $144,771 |
| Expenses. Total of all expenses incurred | 2009-08-31 | $144,771 |
| Benefits paid (including direct rollovers) | 2009-08-31 | $132,387 |
| Total plan assets at end of year | 2009-08-31 | $0 |
| Total plan assets at beginning of year | 2009-08-31 | $0 |
| Total contributions received or receivable from participants | 2009-08-31 | $63,199 |
| Total contributions received or receivable from employer(s) | 2009-08-31 | $81,572 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2009-08-31 | $12,384 |
| 2008 : FIRST COMMUNITY BANK CAFETERIA PLAN 2008 401k financial data |
|---|
| Total plan liabilities at end of year | 2008-08-31 | $0 |
| Total plan liabilities at beginning of year | 2008-08-31 | $0 |
| Total income from all sources | 2008-08-31 | $77,189 |
| Expenses. Total of all expenses incurred | 2008-08-31 | $77,189 |
| Benefits paid (including direct rollovers) | 2008-08-31 | $72,872 |
| Total plan assets at end of year | 2008-08-31 | $0 |
| Total plan assets at beginning of year | 2008-08-31 | $0 |
| Total contributions received or receivable from participants | 2008-08-31 | $30,876 |
| Total contributions received or receivable from employer(s) | 2008-08-31 | $46,313 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2008-08-31 | $4,317 |
| 2007 : FIRST COMMUNITY BANK CAFETERIA PLAN 2007 401k financial data |
|---|
| Total plan liabilities at end of year | 2007-08-31 | $0 |
| Total plan liabilities at beginning of year | 2007-08-31 | $0 |
| Total income from all sources | 2007-08-31 | $59,087 |
| Expenses. Total of all expenses incurred | 2007-08-31 | $59,087 |
| Benefits paid (including direct rollovers) | 2007-08-31 | $55,786 |
| Total plan assets at end of year | 2007-08-31 | $0 |
| Total plan assets at beginning of year | 2007-08-31 | $0 |
| Total contributions received or receivable from participants | 2007-08-31 | $23,635 |
| Total contributions received or receivable from employer(s) | 2007-08-31 | $35,452 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2007-08-31 | $3,301 |
| 2023: FIRST COMMUNITY BANK CAFETERIA PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: FIRST COMMUNITY BANK CAFETERIA PLAN 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 form 5500 responses |
|---|
| 2008-09-01 | Type of plan entity | Single employer plan |
| 2008-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 form 5500 responses |
|---|
| 2007-09-01 | Type of plan entity | Single employer plan |
| 2007-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 form 5500 responses |
|---|
| 2006-09-01 | Type of plan entity | Single employer plan |
| 2006-09-01 | First time form 5500 has been submitted | Yes |
| 2006-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-09-01 | Plan benefit arrangement – Insurance | Yes |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 366 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $107,050 | | Total amount of fees paid to insurance company | USD $150,941 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $765,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251 |
| Policy instance | 1 |
| Insurance contract or identification number | 000006251 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-01 | | Total amount of commissions paid to insurance broker | USD $182 | | Dental Insurance Welfare Benefit | Yes | | 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 | 836854 |
| Policy instance | 2 |
| Insurance contract or identification number | 836854 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2024-01-01 | | Total amount of commissions paid to insurance broker | USD $20,697 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $189,768 | | 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 | 836856 |
| Policy instance | 10 |
| Insurance contract or identification number | 836856 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2024-01-01 | | Total amount of commissions paid to insurance broker | USD $31,533 | | Other welfare benefits provided | LIFESTYLE A D D, LIFESTYLE LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $171,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-10000 |
| Policy instance | 4 |
| Insurance contract or identification number | 000006251-10000 | | Number of Individuals Covered | 771 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $27,850 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-10000 |
| Policy instance | 5 |
| Insurance contract or identification number | 000006251-10000 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,706 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 6 |
| Insurance contract or identification number | 30059830 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $5,769 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-20000 |
| Policy instance | 7 |
| Insurance contract or identification number | 000006251-20000 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,363 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0000171756 |
| Policy instance | 8 |
| Insurance contract or identification number | 0000171756 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2024-01-01 | | Total amount of commissions paid to insurance broker | USD $7,759 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,193 | | 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 | 836855 |
| Policy instance | 9 |
| Insurance contract or identification number | 836855 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2024-01-01 | | Total amount of commissions paid to insurance broker | USD $13,681 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,760 | | 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 | 836854 |
| Policy instance | 2 |
| Insurance contract or identification number | 836854 | | Number of Individuals Covered | 513 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,285 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $205,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ONE BEACON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 0876- ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 351 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $100,825 | | Total amount of fees paid to insurance company | USD $196,609 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $755,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-10000 |
| Policy instance | 4 |
| Insurance contract or identification number | 000006251-10000 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $244 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251 |
| Policy instance | 1 |
| Insurance contract or identification number | 000006251 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,593 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 6 |
| Insurance contract or identification number | 30059830 | | Number of Individuals Covered | 314 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,481 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-20000 |
| Policy instance | 7 |
| Insurance contract or identification number | 000006251-20000 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,803 | | Dental Insurance Welfare Benefit | Yes | | 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 | 836855 |
| Policy instance | 8 |
| Insurance contract or identification number | 836855 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,438 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,587 | | 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 | 836856 |
| Policy instance | 9 |
| Insurance contract or identification number | 836856 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $26,816 | | Other welfare benefits provided | LIFESTYLE A D D, LIFESTYLE LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $178,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251-10000 |
| Policy instance | 5 |
| Insurance contract or identification number | 000006251-10000 | | Number of Individuals Covered | 771 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $27,850 | | Dental Insurance Welfare Benefit | Yes | | 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 | 836854 |
| Policy instance | 2 |
| ONE BEACON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 0876- ) |
| Policy contract number | |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 836855 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 836856 |
| Policy instance | 6 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 836854 |
| Policy instance | 2 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000006251 |
| Policy instance | 1 |
| STANDARD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52413 ) |
| Policy contract number | |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 836856 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 836855 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 12 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 6 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 11 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 10 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 9 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 8 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027617 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028396 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 7 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027616 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028396 |
| Policy instance | 13 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028396 |
| Policy instance | 13 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 12 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 11 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 10 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 9 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 8 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 7 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 6 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027616 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027617 |
| Policy instance | 1 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028396 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30059830 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028396 |
| Policy instance | 3 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 8 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101746801 |
| Policy instance | 14 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101746801 |
| Policy instance | 13 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101746801 |
| Policy instance | 12 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 11 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 10 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 1 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061029 |
| Policy instance | 7 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 9 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061027 |
| Policy instance | 6 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 1 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061027 |
| Policy instance | 6 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061029 |
| Policy instance | 7 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50014152 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 101746801 |
| Policy instance | 8 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: N/A ) |
| Policy contract number | 30035462 |
| Policy instance | 6 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027365 |
| Policy instance | 5 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027366 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 1 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 038894 |
| Policy instance | 4 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 208396 |
| Policy instance | 3 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 858233G |
| Policy instance | 2 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000002338 |
| Policy instance | 1 |
