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FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 401k Plan overview

Plan NameFIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN
Plan identification number 501

FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FIRST COMMUNITY FINANCIAL PARTNERS INC. has sponsored the creation of one or more 401k plans.

    Company Name:FIRST COMMUNITY FINANCIAL PARTNERS INC.
    Employer identification number (EIN):204718752
    NAIC Classification:522120
    NAIC Description:Savings Institutions

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012017-02-01KATHY MIDDLETON
    5012017-02-01LISA DAVIS
    5012016-02-01KATHY MIDDLETON
    5012015-02-01KATHY MIDDLETON
    5012014-02-01KATHY MIDDLETON

    Plan Statistics for FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN

    401k plan membership statisitcs for FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN

    Measure Date Value
    2017: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2017 401k membership
    Total participants, beginning-of-year2017-02-01248
    Total number of active participants reported on line 7a of the Form 55002017-02-01240
    Number of retired or separated participants receiving benefits2017-02-010
    Number of other retired or separated participants entitled to future benefits2017-02-010
    Total of all active and inactive participants2017-02-01240
    2016: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2016 401k membership
    Total participants, beginning-of-year2016-02-01110
    Total number of active participants reported on line 7a of the Form 55002016-02-01248
    Number of retired or separated participants receiving benefits2016-02-010
    Number of other retired or separated participants entitled to future benefits2016-02-010
    Total of all active and inactive participants2016-02-01248
    2015: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2015 401k membership
    Total participants, beginning-of-year2015-02-01102
    Total number of active participants reported on line 7a of the Form 55002015-02-01110
    Number of retired or separated participants receiving benefits2015-02-010
    Number of other retired or separated participants entitled to future benefits2015-02-010
    Total of all active and inactive participants2015-02-01110
    2014: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2014 401k membership
    Total participants, beginning-of-year2014-02-01103
    Total number of active participants reported on line 7a of the Form 55002014-02-01102
    Number of retired or separated participants receiving benefits2014-02-010
    Number of other retired or separated participants entitled to future benefits2014-02-010
    Total of all active and inactive participants2014-02-01102

    Form 5500 Responses for FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN

    2017: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2017 form 5500 responses
    2017-02-01Type of plan entitySingle employer plan
    2017-02-01Submission has been amendedNo
    2017-02-01This submission is the final filingNo
    2017-02-01This return/report is a short plan year return/report (less than 12 months)No
    2017-02-01Plan is a collectively bargained planNo
    2017-02-01Plan funding arrangement – InsuranceYes
    2017-02-01Plan benefit arrangement – InsuranceYes
    2016: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2016 form 5500 responses
    2016-02-01Type of plan entitySingle employer plan
    2016-02-01Submission has been amendedNo
    2016-02-01This submission is the final filingNo
    2016-02-01This return/report is a short plan year return/report (less than 12 months)No
    2016-02-01Plan is a collectively bargained planNo
    2016-02-01Plan funding arrangement – InsuranceYes
    2016-02-01Plan benefit arrangement – InsuranceYes
    2015: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2015 form 5500 responses
    2015-02-01Type of plan entitySingle employer plan
    2015-02-01Submission has been amendedNo
    2015-02-01This submission is the final filingNo
    2015-02-01This return/report is a short plan year return/report (less than 12 months)No
    2015-02-01Plan is a collectively bargained planNo
    2015-02-01Plan funding arrangement – InsuranceYes
    2015-02-01Plan benefit arrangement – InsuranceYes
    2014: FIRST COMMUNITY FINANCIAL PARTNERS INC. LIFE INSURANCE PLAN 2014 form 5500 responses
    2014-02-01Type of plan entitySingle employer plan
    2014-02-01First time form 5500 has been submittedYes
    2014-02-01Submission has been amendedNo
    2014-02-01This submission is the final filingNo
    2014-02-01This return/report is a short plan year return/report (less than 12 months)No
    2014-02-01Plan is a collectively bargained planNo
    2014-02-01Plan funding arrangement – InsuranceYes
    2014-02-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number00001D034653
    Policy instance 6
    Insurance contract or identification number00001D034653
    Number of Individuals Covered89
    Insurance policy start date2017-07-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $2,575
    Total amount of fees paid to insurance companyUSD $2,439
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $48,774
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,575
    Amount paid for insurance broker fees2439
    Additional information about fees paid to insurance brokerCONSULTING FEES
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGVTL0AA2S
    Policy instance 4
    Insurance contract or identification numberGVTL0AA2S
    Number of Individuals Covered54
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $1,841
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $12,277
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,841
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANT INC
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract numberB28071 P32514
    Policy instance 5
    Insurance contract or identification numberB28071 P32514
    Number of Individuals Covered240
    Insurance policy start date2016-07-01
    Insurance policy end date2017-06-30
    Total amount of commissions paid to insurance brokerUSD $48,007
    Total amount of fees paid to insurance companyUSD $846
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,227,191
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $48,007
    Amount paid for insurance broker fees846
    Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS, INC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number00001D034653
    Policy instance 6
    Insurance contract or identification number00001D034653
    Number of Individuals Covered89
    Insurance policy start date2017-07-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $2,575
    Total amount of fees paid to insurance companyUSD $2,439
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $48,774
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,575
    Amount paid for insurance broker fees2439
    Additional information about fees paid to insurance brokerCONSULTING FEES
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0AA2S
    Policy instance 1
    Insurance contract or identification numberGUPR0AA2S
    Number of Individuals Covered69
    Insurance policy start date2017-02-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $2,511
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,608
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,511
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0AA2S
    Policy instance 2
    Insurance contract or identification numberGLUG0AA2S
    Number of Individuals Covered115
    Insurance policy start date2017-02-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $1,597
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $15,968
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,597
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUC0AA2S
    Policy instance 3
    Insurance contract or identification numberGUC0AA2S
    Number of Individuals Covered56
    Insurance policy start date2017-02-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $1,953
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $19,528
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,953
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGVTL0AA2S
    Policy instance 4
    Insurance contract or identification numberGVTL0AA2S
    Number of Individuals Covered46
    Insurance policy start date2017-02-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $1,873
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $12,487
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,873
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANT INC
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract numberB28071 P32514
    Policy instance 5
    Insurance contract or identification numberB28071 P32514
    Number of Individuals Covered227
    Insurance policy start date2016-07-01
    Insurance policy end date2017-06-30
    Total amount of commissions paid to insurance brokerUSD $71,594
    Total amount of fees paid to insurance companyUSD $1,764
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,799,410
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $71,594
    Amount paid for insurance broker fees1764
    Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS, INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUC0AA2S
    Policy instance 3
    Insurance contract or identification numberGUC0AA2S
    Number of Individuals Covered71
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $2,172
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $21,724
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,172
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0AA2S
    Policy instance 2
    Insurance contract or identification numberGLUG0AA2S
    Number of Individuals Covered132
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $1,723
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,231
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,723
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0AA2S
    Policy instance 1
    Insurance contract or identification numberGUPR0AA2S
    Number of Individuals Covered85
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $2,690
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $21,724
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,690
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0AA2S
    Policy instance 1
    Insurance contract or identification numberGUPR0AA2S
    Number of Individuals Covered75
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $2,354
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,040
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,354
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0AA2S
    Policy instance 2
    Insurance contract or identification numberGLUG0AA2S
    Number of Individuals Covered110
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $1,423
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,228
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,423
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUC0AA2S
    Policy instance 3
    Insurance contract or identification numberGUC0AA2S
    Number of Individuals Covered58
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $1,693
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,932
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,693
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANTS INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGVTL0AA2S
    Policy instance 4
    Insurance contract or identification numberGVTL0AA2S
    Number of Individuals Covered42
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $1,572
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $10,479
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,572
    Insurance broker organization code?3
    Insurance broker nameAFFILIATED BENEFIT CONSULTANT INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGVTL0AA2S
    Policy instance 4
    Insurance contract or identification numberGVTL0AA2S
    Number of Individuals Covered37
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $1,606
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $10,705
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,170
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF NORTHERN IL INC.
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUC0AA2S
    Policy instance 3
    Insurance contract or identification numberGUC0AA2S
    Number of Individuals Covered54
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $1,676
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,760
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,251
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF NORTHERN IL INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0AA2S
    Policy instance 2
    Insurance contract or identification numberGLUG0AA2S
    Number of Individuals Covered102
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $1,391
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $13,904
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,050
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF NORTHERN IL INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGUPR0AA2S
    Policy instance 1
    Insurance contract or identification numberGUPR0AA2S
    Number of Individuals Covered68
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $2,302
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $15,515
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,714
    Insurance broker organization code?3
    Insurance broker nameBROWN AND BROWN OF NORTHERN IL INC.

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