401k Plan data: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN plan

FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN
Plan identification number	501

FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN Benefits

401k Plan Type	Other Pension Benefit
Plan Features/Benefits	Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)). Health (other than dental or vision) Life insurance Vision

401k Sponsoring company profile

FIRST PIEDMONT CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: FIRST PIEDMONT CORPORATION

Employer identification number (EIN): 540883009

NAIC Classification: 562000

Additional information about FIRST PIEDMONT CORPORATION

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1969-07-11

Company Identification Number: 0121972

Legal Registered Office Address: P O BOX 1069
108 S MAIN ST / PO BOX 1069
CHATHAM
United States of America (USA)
24531

More information about FIRST PIEDMONT CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 THOMAS S. STUMP
501 2011-01-01 THOMAS STUMP THOMAS STUMP 2015-11-09
501 2010-01-01
501 2009-01-01
501 2008-01-01

Plan Statistics for FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN

401k plan membership statisitcs for FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN

Measure Date Value
2015: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 120
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 120
2014: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 110
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 110
2013: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 119
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 119
2012: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 109
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 109
2011: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 109
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 109
2010: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 102
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 107
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0
2008: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 103
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
Total participants 2008-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 0

Measure	Date	Value
2015: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	120
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	120
2014: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	110
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	110
2013: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	119
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	119
2012: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	109
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	109
2011: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	109
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	109
2010: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	102
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	107
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2008: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	103
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
Total participants	2008-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	0

Financial Data on FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN

Measure	Date	Value
2015 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$378,729
Expenses. Total of all expenses incurred	2015-12-31	$378,729
Benefits paid (including direct rollovers)	2015-12-31	$378,729
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$0
Total contributions received or receivable from participants	2015-12-31	$378,729
Net income (gross income less expenses)	2015-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$0
2014 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$322,865
Expenses. Total of all expenses incurred	2014-12-31	$322,865
Benefits paid (including direct rollovers)	2014-12-31	$322,865
Total plan assets at end of year	2014-12-31	$0
Total plan assets at beginning of year	2014-12-31	$0
Total contributions received or receivable from participants	2014-12-31	$322,865
Net income (gross income less expenses)	2014-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
2013 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$309,308
Expenses. Total of all expenses incurred	2013-12-31	$309,308
Benefits paid (including direct rollovers)	2013-12-31	$309,308
Total plan assets at end of year	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$309,308
Net income (gross income less expenses)	2013-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
2012 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$304,954
Expenses. Total of all expenses incurred	2012-12-31	$304,954
Benefits paid (including direct rollovers)	2012-12-31	$304,954
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$304,954
Net income (gross income less expenses)	2012-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
2011 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$0
Total plan assets at beginning of year	2011-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$0
2010 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$319,728
Expenses. Total of all expenses incurred	2010-12-31	$319,728
Benefits paid (including direct rollovers)	2010-12-31	$319,728
Total plan assets at end of year	2010-12-31	$0
Total plan assets at beginning of year	2010-12-31	$0
Total contributions received or receivable from participants	2010-12-31	$319,728
Net income (gross income less expenses)	2010-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
2009 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2009 401k financial data
Total plan liabilities at end of year	2009-12-31	$0
Total plan liabilities at beginning of year	2009-12-31	$0
Total income from all sources	2009-12-31	$237,404
Expenses. Total of all expenses incurred	2009-12-31	$237,404
Benefits paid (including direct rollovers)	2009-12-31	$237,404
Total plan assets at end of year	2009-12-31	$0
Total plan assets at beginning of year	2009-12-31	$0
Total contributions received or receivable from participants	2009-12-31	$237,404
Net income (gross income less expenses)	2009-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2009-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2009-12-31	$0
2008 : FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2008 401k financial data
Total plan liabilities at end of year	2008-12-31	$0
Total plan liabilities at beginning of year	2008-12-31	$0
Total income from all sources	2008-12-31	$241,953
Expenses. Total of all expenses incurred	2008-12-31	$241,953
Benefits paid (including direct rollovers)	2008-12-31	$241,953
Total plan assets at end of year	2008-12-31	$0
Total plan assets at beginning of year	2008-12-31	$0
Total contributions received or receivable from participants	2008-12-31	$241,953
Net income (gross income less expenses)	2008-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$0

Form 5500 Responses for FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN

2015: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: FIRST PIEDMONT AND AFFILIATES WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	First time form 5500 has been submitted	Yes
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SH-COVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 96555 )

Policy contract number

9320770000

Policy instance

Insurance contract or identification number	9320770000
Number of Individuals Covered	120
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,072
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $378,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SH-COVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 96555 )

Policy contract number

9320770000

Policy instance

Insurance contract or identification number	9320770000
Number of Individuals Covered	110
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $322,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

A2R8P

Policy instance

Insurance contract or identification number	A2R8P
Number of Individuals Covered	0
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

A2R8P

Policy instance

Insurance contract or identification number	A2R8P
Number of Individuals Covered	119
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $296,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

42768000V

Policy instance

Insurance contract or identification number	42768000V
Number of Individuals Covered	119
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

A2R8P

Policy instance

Insurance contract or identification number	A2R8P
Number of Individuals Covered	109
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $292,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

42768000V

Policy instance

Insurance contract or identification number	42768000V
Number of Individuals Covered	109
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

A2R8P

Policy instance

Insurance contract or identification number	A2R8P
Number of Individuals Covered	109
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

42768000V

Policy instance

Insurance contract or identification number	42768000V
Number of Individuals Covered	109
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

42768000V

Policy instance

Insurance contract or identification number	42768000V
Number of Individuals Covered	102
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

A2R8P

Policy instance

Insurance contract or identification number	A2R8P
Number of Individuals Covered	102
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $306,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FHM400971

Policy instance

Insurance contract or identification number	FHM400971
Number of Individuals Covered	107
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $3,097
Total amount of fees paid to insurance company	USD $41,616
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,097
Amount paid for insurance broker fees	26401
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	GATEWAY HEALTH ALLIANCE

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FHM400971

Policy instance

Insurance contract or identification number	FHM400971
Number of Individuals Covered	103
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $2,827
Total amount of fees paid to insurance company	USD $39,198
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,827
Amount paid for insurance broker fees	24095
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	GATEWAY HEALTH ALLIANCE

Potentially related plans

FIRST PIEDMONT SAVINGS & LOAN PROFIT SHARING PLAN [EIN = 570226455]

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Company Name:	FIRST PIEDMONT CORPORATION
Employer identification number (EIN):	540883009
NAIC Classification:	562000

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1969-07-11
Company Identification Number:	0121972
Legal Registered Office Address:	P O BOX 1069 108 S MAIN ST / PO BOX 1069 CHATHAM United States of America (USA) 24531