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FIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameFIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN
Plan identification number 501

FIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FIRST COMMUNITY MORTGAGE, INC has sponsored the creation of one or more 401k plans.

    Company Name:FIRST COMMUNITY MORTGAGE, INC
    Employer identification number (EIN):412031753
    NAIC Classification:522292
    NAIC Description:Real Estate Credit

    Additional information about FIRST COMMUNITY MORTGAGE, INC

    Jurisdiction of Incorporation: State of Delaware Division of Corporations
    Incorporation Date:
    Company Identification Number: 5802937

    More information about FIRST COMMUNITY MORTGAGE, INC

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012022-04-01
    5012021-04-01
    5012020-04-01
    5012019-04-01
    5012018-04-01
    5012017-04-01TAMMIE RUSSELL
    5012016-04-01TAMMIE RUSSELL
    5012015-04-01MARIE ALVAREZ
    5012014-04-01MARIE ALVAREZ
    5012013-04-01
    5012012-04-01JENNIFER FAUCETT
    5012011-04-01JENNIFER FAUCETT

    Plan Statistics for FIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN

    401k plan membership statisitcs for FIRST COMMUNITY MORTGAGE WELFARE BENEFIT PLAN

    Measure Date Value
    2022
    Total participants, beginning-of-year2022-04-01334
    Total number of active participants reported on line 7a of the Form 55002022-04-01400
    Number of retired or separated participants receiving benefits2022-04-010
    Number of other retired or separated participants entitled to future benefits2022-04-010
    Total of all active and inactive participants2022-04-01400
    2021
    Total participants, beginning-of-year2021-04-01379
    Total number of active participants reported on line 7a of the Form 55002021-04-01334
    Number of retired or separated participants receiving benefits2021-04-010
    Number of other retired or separated participants entitled to future benefits2021-04-010
    Total of all active and inactive participants2021-04-01334
    2020
    Total participants, beginning-of-year2020-04-01272
    Total number of active participants reported on line 7a of the Form 55002020-04-01379
    Number of retired or separated participants receiving benefits2020-04-010
    Number of other retired or separated participants entitled to future benefits2020-04-010
    Total of all active and inactive participants2020-04-01379
    2019
    Total participants, beginning-of-year2019-04-01262
    Total number of active participants reported on line 7a of the Form 55002019-04-01272
    Number of retired or separated participants receiving benefits2019-04-010
    Number of other retired or separated participants entitled to future benefits2019-04-010
    Total of all active and inactive participants2019-04-01272
    2018
    Total participants, beginning-of-year2018-04-01302
    Total number of active participants reported on line 7a of the Form 55002018-04-01262
    Number of retired or separated participants receiving benefits2018-04-010
    Number of other retired or separated participants entitled to future benefits2018-04-010
    Total of all active and inactive participants2018-04-01262
    2017
    Total participants, beginning-of-year2017-04-01302
    Total number of active participants reported on line 7a of the Form 55002017-04-01302
    Number of retired or separated participants receiving benefits2017-04-010
    Number of other retired or separated participants entitled to future benefits2017-04-010
    Total of all active and inactive participants2017-04-01302
    2016
    Total participants, beginning-of-year2016-04-01257
    Total number of active participants reported on line 7a of the Form 55002016-04-01302
    Number of retired or separated participants receiving benefits2016-04-010
    Number of other retired or separated participants entitled to future benefits2016-04-010
    Total of all active and inactive participants2016-04-01302
    2015
    Total participants, beginning-of-year2015-04-01191
    Total number of active participants reported on line 7a of the Form 55002015-04-01257
    Number of retired or separated participants receiving benefits2015-04-010
    Number of other retired or separated participants entitled to future benefits2015-04-010
    Total of all active and inactive participants2015-04-01257
    2014
    Total participants, beginning-of-year2014-04-01157
    Total number of active participants reported on line 7a of the Form 55002014-04-01191
    Number of retired or separated participants receiving benefits2014-04-010
    Number of other retired or separated participants entitled to future benefits2014-04-010
    Total of all active and inactive participants2014-04-01191
    2013
    Total participants, beginning-of-year2013-04-01171
    Total number of active participants reported on line 7a of the Form 55002013-04-01157
    Number of retired or separated participants receiving benefits2013-04-010
    Number of other retired or separated participants entitled to future benefits2013-04-010
    Total of all active and inactive participants2013-04-01157
    Total participants2013-04-01157
    2012
    Total participants, beginning-of-year2012-04-01129
    Total number of active participants reported on line 7a of the Form 55002012-04-01165
    Number of retired or separated participants receiving benefits2012-04-010
    Number of other retired or separated participants entitled to future benefits2012-04-010
    Total of all active and inactive participants2012-04-01165
    Total participants2012-04-01165
    2011
    Total participants, beginning-of-year2011-04-01128
    Total number of active participants reported on line 7a of the Form 55002011-04-01127
    Number of retired or separated participants receiving benefits2011-04-010
    Number of other retired or separated participants entitled to future benefits2011-04-010
    Total of all active and inactive participants2011-04-01127
    Total participants2011-04-01127

    Form 5500 Responses

    2022
    2022-04-01Type of plan entitySingle employer plan
    2022-04-01Submission has been amendedNo
    2022-04-01This submission is the final filingNo
    2022-04-01This return/report is a short plan year return/report (less than 12 months)No
    2022-04-01Plan is a collectively bargained planNo
    2022-04-01Plan funding arrangement – InsuranceYes
    2022-04-01Plan benefit arrangement – InsuranceYes
    2021
    2021-04-01Type of plan entitySingle employer plan
    2021-04-01Submission has been amendedNo
    2021-04-01This submission is the final filingNo
    2021-04-01This return/report is a short plan year return/report (less than 12 months)No
    2021-04-01Plan is a collectively bargained planNo
    2021-04-01Plan funding arrangement – InsuranceYes
    2021-04-01Plan benefit arrangement – InsuranceYes
    2020
    2020-04-01Type of plan entitySingle employer plan
    2020-04-01Submission has been amendedNo
    2020-04-01This submission is the final filingNo
    2020-04-01This return/report is a short plan year return/report (less than 12 months)No
    2020-04-01Plan is a collectively bargained planNo
    2020-04-01Plan funding arrangement – InsuranceYes
    2020-04-01Plan benefit arrangement – InsuranceYes
    2019
    2019-04-01Type of plan entitySingle employer plan
    2019-04-01Submission has been amendedNo
    2019-04-01This submission is the final filingNo
    2019-04-01This return/report is a short plan year return/report (less than 12 months)No
    2019-04-01Plan is a collectively bargained planNo
    2019-04-01Plan funding arrangement – InsuranceYes
    2019-04-01Plan benefit arrangement – InsuranceYes
    2018
    2018-04-01Type of plan entitySingle employer plan
    2018-04-01Submission has been amendedNo
    2018-04-01This submission is the final filingNo
    2018-04-01This return/report is a short plan year return/report (less than 12 months)No
    2018-04-01Plan is a collectively bargained planNo
    2018-04-01Plan funding arrangement – InsuranceYes
    2018-04-01Plan benefit arrangement – InsuranceYes
    2017
    2017-04-01Type of plan entitySingle employer plan
    2017-04-01Submission has been amendedNo
    2017-04-01This submission is the final filingNo
    2017-04-01This return/report is a short plan year return/report (less than 12 months)No
    2017-04-01Plan is a collectively bargained planNo
    2017-04-01Plan funding arrangement – InsuranceYes
    2017-04-01Plan benefit arrangement – InsuranceYes
    2016
    2016-04-01Type of plan entitySingle employer plan
    2016-04-01Submission has been amendedNo
    2016-04-01This submission is the final filingNo
    2016-04-01This return/report is a short plan year return/report (less than 12 months)No
    2016-04-01Plan is a collectively bargained planNo
    2016-04-01Plan funding arrangement – InsuranceYes
    2016-04-01Plan benefit arrangement – InsuranceYes
    2015
    2015-04-01Type of plan entitySingle employer plan
    2015-04-01Submission has been amendedNo
    2015-04-01This submission is the final filingNo
    2015-04-01This return/report is a short plan year return/report (less than 12 months)No
    2015-04-01Plan is a collectively bargained planNo
    2015-04-01Plan funding arrangement – InsuranceYes
    2015-04-01Plan benefit arrangement – InsuranceYes
    2014
    2014-04-01Type of plan entitySingle employer plan
    2014-04-01Submission has been amendedNo
    2014-04-01This submission is the final filingNo
    2014-04-01This return/report is a short plan year return/report (less than 12 months)No
    2014-04-01Plan is a collectively bargained planNo
    2014-04-01Plan funding arrangement – InsuranceYes
    2014-04-01Plan benefit arrangement – InsuranceYes
    2013
    2013-04-01Type of plan entitySingle employer plan
    2013-04-01Submission has been amendedNo
    2013-04-01This submission is the final filingNo
    2013-04-01This return/report is a short plan year return/report (less than 12 months)No
    2013-04-01Plan is a collectively bargained planNo
    2013-04-01Plan funding arrangement – InsuranceYes
    2013-04-01Plan benefit arrangement – InsuranceYes
    2012
    2012-04-01Type of plan entitySingle employer plan
    2012-04-01Submission has been amendedNo
    2012-04-01This submission is the final filingNo
    2012-04-01This return/report is a short plan year return/report (less than 12 months)No
    2012-04-01Plan is a collectively bargained planNo
    2012-04-01Plan funding arrangement – InsuranceYes
    2012-04-01Plan benefit arrangement – InsuranceYes
    2011
    2011-04-01Type of plan entitySingle employer plan
    2011-04-01First time form 5500 has been submittedYes
    2011-04-01Submission has been amendedNo
    2011-04-01This submission is the final filingNo
    2011-04-01This return/report is a short plan year return/report (less than 12 months)No
    2011-04-01Plan is a collectively bargained planNo
    2011-04-01Plan funding arrangement – InsuranceYes
    2011-04-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-017742-00
    Policy instance 5
    Insurance contract or identification number01-017742-00
    Number of Individuals Covered400
    Insurance policy start date2022-04-01
    Insurance policy end date2023-03-31
    Total amount of commissions paid to insurance brokerUSD $16,215
    Total amount of fees paid to insurance companyUSD $8,130
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $132,357
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,236
    Amount paid for insurance broker fees6044
    Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
    Insurance broker organization code?3
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-047637
    Policy instance 4
    Insurance contract or identification number010-047637
    Number of Individuals Covered728
    Insurance policy start date2022-04-01
    Insurance policy end date2023-03-31
    Total amount of commissions paid to insurance brokerUSD $2,509
    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 BenefitYes
    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 $41,813
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,509
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
    Policy contract number7243
    Policy instance 3
    Insurance contract or identification number7243
    Number of Individuals Covered659
    Insurance policy start date2022-04-01
    Insurance policy end date2023-03-31
    Total amount of commissions paid to insurance brokerUSD $11,408
    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 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 $0
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,408
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
    Policy contract number0000021487
    Policy instance 2
    Insurance contract or identification number0000021487
    Number of Individuals Covered151
    Insurance policy start date2022-04-01
    Insurance policy end date2023-03-31
    Total amount of commissions paid to insurance brokerUSD $24,524
    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
    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 $106,933
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,916
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISION
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered625
    Insurance policy start date2022-04-01
    Insurance policy end date2023-03-31
    Total amount of commissions paid to insurance brokerUSD $57,798
    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 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 $595,425
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $57,798
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered472
    Insurance policy start date2021-04-01
    Insurance policy end date2022-03-31
    Total amount of commissions paid to insurance brokerUSD $80,080
    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 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 $2,166
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $80,080
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
    Policy contract number0000021487
    Policy instance 2
    Insurance contract or identification number0000021487
    Number of Individuals Covered432
    Insurance policy start date2021-04-01
    Insurance policy end date2022-03-31
    Total amount of commissions paid to insurance brokerUSD $21,475
    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
    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 $158,740
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,011
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISION
    Insurance broker organization code?3
    DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
    Policy contract number7243
    Policy instance 3
    Insurance contract or identification number7243
    Number of Individuals Covered500
    Insurance policy start date2021-04-01
    Insurance policy end date2022-03-31
    Total amount of commissions paid to insurance brokerUSD $10,608
    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 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 $0
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,608
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-047637
    Policy instance 4
    Insurance contract or identification number010-047637
    Number of Individuals Covered594
    Insurance policy start date2021-04-01
    Insurance policy end date2022-03-31
    Total amount of commissions paid to insurance brokerUSD $2,048
    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 BenefitYes
    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 $0
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,048
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-017742-00
    Policy instance 5
    Insurance contract or identification number01-017742-00
    Number of Individuals Covered334
    Insurance policy start date2021-04-01
    Insurance policy end date2022-03-31
    Total amount of commissions paid to insurance brokerUSD $19,449
    Total amount of fees paid to insurance companyUSD $2,733
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $157,740
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,876
    Amount paid for insurance broker fees2733
    Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
    Insurance broker organization code?3
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-017742-00
    Policy instance 5
    Insurance contract or identification number01-017742-00
    Number of Individuals Covered379
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $15,612
    Total amount of fees paid to insurance companyUSD $4,126
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,740
    Amount paid for insurance broker fees4126
    Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
    Insurance broker organization code?3
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-047637
    Policy instance 4
    Insurance contract or identification number010-047637
    Number of Individuals Covered673
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $1,462
    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 BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,462
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
    Policy contract number7243
    Policy instance 3
    Insurance contract or identification number7243
    Number of Individuals Covered549
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $7,670
    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 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,670
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
    Policy contract number0000021487
    Policy instance 2
    Insurance contract or identification number0000021487
    Number of Individuals Covered432
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $24,655
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,469
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISIONS
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered520
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $67,492
    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 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $67,492
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-017742-00
    Policy instance 5
    Insurance contract or identification number01-017742-00
    Number of Individuals Covered272
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $14,545
    Total amount of fees paid to insurance companyUSD $944
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $0
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,869
    Amount paid for insurance broker fees944
    Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
    Insurance broker organization code?3
    AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
    Policy contract number010-047637
    Policy instance 4
    Insurance contract or identification number010-047637
    Number of Individuals Covered492
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $1,627
    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 BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,627
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
    Policy contract number7243
    Policy instance 3
    Insurance contract or identification number7243
    Number of Individuals Covered379
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $6,513
    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 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 $0
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,513
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
    Policy contract number0000021487
    Policy instance 2
    Insurance contract or identification number0000021487
    Number of Individuals Covered395
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $17,435
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,659
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSION
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered350
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $57,538
    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 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 $1,818
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $57,538
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10811
    Policy instance 4
    Insurance contract or identification number10811
    Number of Individuals Covered0
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $5,888
    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 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,888
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSION
    Insurance broker organization code?3
    Insurance broker nameMILLER LOUGHRY INSURANCE
    CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
    Policy contract number0000021487
    Policy instance 3
    Insurance contract or identification number0000021487
    Number of Individuals Covered305
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $32,217
    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
    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 $102,170
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,258
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSION
    Insurance broker organization code?3
    Insurance broker nameMARY DAHLIN
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000B5VH
    Policy instance 2
    Insurance contract or identification numberG000B5VH
    Number of Individuals Covered336
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $16,773
    Total amount of fees paid to insurance companyUSD $3,162
    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 BenefitYes
    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 $167,736
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,773
    Amount paid for insurance broker fees3162
    Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
    Insurance broker organization code?3
    Insurance broker nameMILLER LOUGHRY BEACH INS. SVCS. INC
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered515
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $95,382
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $36,442
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $95,382
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameCHASE SINQUEFIELD
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered412
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $41,003
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $26,277
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25,963
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameCHASE SINQUEFIELD
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number246692300
    Policy instance 2
    Insurance contract or identification number246692300
    Number of Individuals Covered197
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $2,092
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOL LIFE, VOLD DEP 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 $29,895
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,092
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameAON CONSULTING
    STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
    Policy contract number159500
    Policy instance 3
    Insurance contract or identification number159500
    Number of Individuals Covered261
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $11,783
    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 BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,284
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMILLER LOUGHRY BEACH INS SVCS
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number246692300
    Policy instance 2
    Insurance contract or identification number246692300
    Number of Individuals Covered197
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $8,329
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOL LIFE, VOLD DEP 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 $120,446
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,253
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameFINANCIAL PRODUCTS AND SERVICES
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered380
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $32,764
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $24,791
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,991
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameWENDELL AGNEW
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number246-6923-00
    Policy instance 2
    Insurance contract or identification number246-6923-00
    Number of Individuals Covered202
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $8,009
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOL LIFE, VOL DEP 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 $116,540
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,009
    Insurance broker nameFINANCIAL PRODUCTS, AN
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered325
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $49,767
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $1,236,631
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees49767
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameHUBERT MOORE
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered316
    Insurance policy start date2012-04-01
    Insurance policy end date2013-03-31
    Total amount of commissions paid to insurance brokerUSD $59,024
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    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 $958,449
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees59024
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameHUBERT MOORE
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number246-6923-00
    Policy instance 2
    Insurance contract or identification number246-6923-00
    Number of Individuals Covered182
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $5,440
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOL LIFE, VOL DEP 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 $81,100
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,440
    Insurance broker nameFINANCIAL PRODUCTS, AN
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
    Policy contract number103005
    Policy instance 1
    Insurance contract or identification number103005
    Number of Individuals Covered245
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $45,130
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $702,012
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number246-6923-00
    Policy instance 2
    Insurance contract or identification number246-6923-00
    Number of Individuals Covered137
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $4,772
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE; VOLUNTARY DEPENDENT 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 $76,745
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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