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FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 401k Plan overview

Plan NameFIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN
Plan identification number 504

FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:FIRST COMMUNITY BANCSHARES, INC.
Employer identification number (EIN):550694814
NAIC Classification:522110
NAIC Description:Commercial Banking

Additional information about FIRST COMMUNITY BANCSHARES, INC.

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1997-07-28
Company Identification Number: 19971230456
Legal Registered Office Address: 2215-B RENAISSANCE DR

LAS VEGAS
United States of America (USA)
89119

More information about FIRST COMMUNITY BANCSHARES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-01-01MELISSA BAILEY2024-01-26
5042021-01-01
5042020-01-01MELISSA BAILEY2021-10-12
5042019-01-01MELISSA WARD2020-10-14
5042018-01-01MELISSA WARD2019-09-03
5042017-01-01
5042016-01-01
5042015-01-01MELISSA WARD, SPHR
5042014-01-01MELISSA WARD, SPHR
5042013-01-01JUDITH N. SWEGER
5042012-01-01JUDITH N. SWEGER
5042011-01-01JUDITH N. SWEGER JUDITH N. SWEGER2012-10-16
5042009-01-01JUDITH N. SWEGER

Plan Statistics for FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN

401k plan membership statisitcs for FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN

Measure Date Value
2022: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01516
Total number of active participants reported on line 7a of the Form 55002022-01-01495
Number of retired or separated participants receiving benefits2022-01-0116
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01511
2021: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01470
Total number of active participants reported on line 7a of the Form 55002021-01-01441
Number of retired or separated participants receiving benefits2021-01-0117
Number of other retired or separated participants entitled to future benefits2021-01-0158
Total of all active and inactive participants2021-01-01516
2020: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01572
Total number of active participants reported on line 7a of the Form 55002020-01-01465
Number of retired or separated participants receiving benefits2020-01-015
Total of all active and inactive participants2020-01-01470
2019: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01576
Total number of active participants reported on line 7a of the Form 55002019-01-01547
Number of retired or separated participants receiving benefits2019-01-0125
Total of all active and inactive participants2019-01-01572
2018: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01607
Total number of active participants reported on line 7a of the Form 55002018-01-01550
Number of retired or separated participants receiving benefits2018-01-0126
Total of all active and inactive participants2018-01-01576
2017: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01644
Total number of active participants reported on line 7a of the Form 55002017-01-01581
Number of retired or separated participants receiving benefits2017-01-0126
Total of all active and inactive participants2017-01-01607
2016: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01565
Total number of active participants reported on line 7a of the Form 55002016-01-01614
Number of retired or separated participants receiving benefits2016-01-0130
Total of all active and inactive participants2016-01-01644
2015: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01578
Total number of active participants reported on line 7a of the Form 55002015-01-01529
Number of retired or separated participants receiving benefits2015-01-0136
Total of all active and inactive participants2015-01-01565
2014: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01620
Total number of active participants reported on line 7a of the Form 55002014-01-01595
Number of retired or separated participants receiving benefits2014-01-0140
Total of all active and inactive participants2014-01-01635
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
2013: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01765
Total number of active participants reported on line 7a of the Form 55002013-01-01576
Number of retired or separated participants receiving benefits2013-01-0145
Total of all active and inactive participants2013-01-01621
2012: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01646
Total number of active participants reported on line 7a of the Form 55002012-01-01590
Number of retired or separated participants receiving benefits2012-01-0157
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01647
2011: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01737
Total number of active participants reported on line 7a of the Form 55002011-01-01515
Number of retired or separated participants receiving benefits2011-01-0165
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01580
2009: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01688
Total number of active participants reported on line 7a of the Form 55002009-01-01547
Number of retired or separated participants receiving benefits2009-01-0175
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01622

Financial Data on FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN

Measure Date Value
2022 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$59,156
Total income from all sources (including contributions)2022-12-31$5,656,021
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$5,342,978
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$5,055,663
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$5,653,950
Value of total assets at end of year2022-12-31$562,470
Value of total assets at beginning of year2022-12-31$308,583
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$287,315
Total interest from all sources2022-12-31$2,071
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$10,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,955,683
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$80,289
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$2,011
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$9,130
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$287,315
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$313,043
Value of net assets at end of year (total assets less liabilities)2022-12-31$562,470
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$249,427
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Income. Interest from US Government securities2022-12-31$2,071
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$1,103,378
Asset value of US Government securities at end of year2022-12-31$482,181
Asset value of US Government securities at beginning of year2022-12-31$306,572
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$3,698,267
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,952,285
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$50,026
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CROWE LLP
Accountancy firm EIN2022-12-31350921680
2021 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$59,156
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$111,414
Total income from all sources (including contributions)2021-12-31$5,759,568
Total of all expenses incurred2021-12-31$5,685,317
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$5,428,351
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$5,759,533
Value of total assets at end of year2021-12-31$308,583
Value of total assets at beginning of year2021-12-31$286,590
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$256,966
Total interest from all sources2021-12-31$35
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$10,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,882,052
Participant contributions at beginning of year2021-12-31$3,736
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$2,011
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$261,420
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$9,130
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$111,414
Administrative expenses (other) incurred2021-12-31$256,966
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$74,251
Value of net assets at end of year (total assets less liabilities)2021-12-31$249,427
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$175,176
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Income. Interest from corporate debt instruments2021-12-31$35
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$1,059,066
Asset value of US Government securities at end of year2021-12-31$306,572
Asset value of US Government securities at beginning of year2021-12-31$21,434
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$3,877,481
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$4,369,285
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$50,026
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN2021-12-31570381582
2020 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$111,414
Total income from all sources (including contributions)2020-12-31$6,134,178
Total of all expenses incurred2020-12-31$6,238,702
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$5,945,370
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$6,133,802
Value of total assets at end of year2020-12-31$286,590
Value of total assets at beginning of year2020-12-31$279,700
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$293,332
Total interest from all sources2020-12-31$376
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$10,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,982,071
Participant contributions at end of year2020-12-31$3,736
Participant contributions at beginning of year2020-12-31$2,247
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$261,420
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$118,398
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$111,414
Administrative expenses (other) incurred2020-12-31$293,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-104,524
Value of net assets at end of year (total assets less liabilities)2020-12-31$175,176
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$279,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Income. Interest from US Government securities2020-12-31$376
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,402,445
Asset value of US Government securities at end of year2020-12-31$21,434
Asset value of US Government securities at beginning of year2020-12-31$159,055
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$4,151,731
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$4,542,925
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2020-12-31560747981
2019 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2019 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$7,131
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$7,131
Total income from all sources (including contributions)2019-12-31$4,883,084
Total income from all sources (including contributions)2019-12-31$4,883,084
Total of all expenses incurred2019-12-31$4,786,998
Total of all expenses incurred2019-12-31$4,786,998
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,549,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,549,007
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,880,410
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,880,410
Value of total assets at end of year2019-12-31$279,700
Value of total assets at end of year2019-12-31$279,700
Value of total assets at beginning of year2019-12-31$190,745
Value of total assets at beginning of year2019-12-31$190,745
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$237,991
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$237,991
Total interest from all sources2019-12-31$2,674
Total interest from all sources2019-12-31$2,674
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$10,000,000
Value of fidelity bond cover2019-12-31$10,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,614,928
Contributions received from participants2019-12-31$1,614,928
Participant contributions at end of year2019-12-31$2,247
Participant contributions at end of year2019-12-31$2,247
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$118,398
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$118,398
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$105,212
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$105,212
Administrative expenses (other) incurred2019-12-31$237,991
Administrative expenses (other) incurred2019-12-31$237,991
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$96,086
Value of net income/loss2019-12-31$96,086
Value of net assets at end of year (total assets less liabilities)2019-12-31$279,700
Value of net assets at end of year (total assets less liabilities)2019-12-31$279,700
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$183,614
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$183,614
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Income. Interest from US Government securities2019-12-31$2,674
Income. Interest from US Government securities2019-12-31$2,674
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,094,109
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,094,109
Asset value of US Government securities at end of year2019-12-31$159,055
Asset value of US Government securities at end of year2019-12-31$159,055
Asset value of US Government securities at beginning of year2019-12-31$85,533
Asset value of US Government securities at beginning of year2019-12-31$85,533
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,265,482
Contributions received in cash from employer2019-12-31$3,265,482
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$3,454,898
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$3,454,898
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$7,131
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$7,131
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm name2019-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2019-12-31560747981
Accountancy firm EIN2019-12-31560747981
2018 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$7,131
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$140,771
Total income from all sources (including contributions)2018-12-31$4,782,568
Total of all expenses incurred2018-12-31$5,370,329
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$5,116,607
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,778,833
Value of total assets at end of year2018-12-31$190,745
Value of total assets at beginning of year2018-12-31$912,146
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$253,722
Total interest from all sources2018-12-31$3,735
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,597,628
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$1,523
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$105,212
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$340,252
Administrative expenses (other) incurred2018-12-31$253,722
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-587,761
Value of net assets at end of year (total assets less liabilities)2018-12-31$183,614
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$771,375
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Income. Interest from US Government securities2018-12-31$3,735
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$109,696
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$109,696
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$996,394
Asset value of US Government securities at end of year2018-12-31$85,533
Asset value of US Government securities at beginning of year2018-12-31$460,675
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,181,205
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$4,120,213
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$7,131
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$140,771
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2018-12-31560747981
2017 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$140,771
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$67,139
Total income from all sources (including contributions)2017-12-31$4,453,265
Total of all expenses incurred2017-12-31$4,273,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$4,006,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$4,451,128
Value of total assets at end of year2017-12-31$912,146
Value of total assets at beginning of year2017-12-31$658,401
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$267,107
Total interest from all sources2017-12-31$2,137
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$20,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,532,593
Participant contributions at end of year2017-12-31$1,523
Participant contributions at beginning of year2017-12-31$45,308
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$340,252
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$149,718
Administrative expenses (other) incurred2017-12-31$267,107
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$180,113
Value of net assets at end of year (total assets less liabilities)2017-12-31$771,375
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$591,262
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Income. Interest from US Government securities2017-12-31$2,137
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$109,696
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$172,182
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$172,182
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$757,493
Asset value of US Government securities at end of year2017-12-31$460,675
Asset value of US Government securities at beginning of year2017-12-31$291,193
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$2,918,535
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,248,552
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$140,771
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$67,139
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2017-12-31560747981
2016 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$67,139
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$81,898
Total income from all sources (including contributions)2016-12-31$4,848,310
Total of all expenses incurred2016-12-31$4,751,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,457,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$4,848,210
Value of total assets at end of year2016-12-31$658,401
Value of total assets at beginning of year2016-12-31$576,205
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$294,329
Total interest from all sources2016-12-31$100
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$20,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,732,641
Participant contributions at end of year2016-12-31$45,308
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$149,718
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$245,167
Administrative expenses (other) incurred2016-12-31$294,329
Liabilities. Value of operating payables at beginning of year2016-12-31$81,898
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$96,955
Value of net assets at end of year (total assets less liabilities)2016-12-31$591,262
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$494,307
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Income. Interest from US Government securities2016-12-31$100
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$172,182
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$124,266
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$124,266
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$762,536
Asset value of US Government securities at end of year2016-12-31$291,193
Asset value of US Government securities at beginning of year2016-12-31$206,772
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$3,115,569
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$3,694,490
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$67,139
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2016-12-31560747981
2015 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$686,996
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$756,475
Total income from all sources (including contributions)2015-12-31$4,119,064
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$4,522,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$4,160,273
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,118,989
Value of total assets at end of year2015-12-31$576,205
Value of total assets at beginning of year2015-12-31$1,049,006
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$362,113
Total interest from all sources2015-12-31$75
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$20,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,686,064
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$245,167
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$110,080
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$79,138
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$81,220
Administrative expenses (other) incurred2015-12-31$550
Liabilities. Value of operating payables at end of year2015-12-31$81,898
Liabilities. Value of operating payables at beginning of year2015-12-31$3,351
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-403,322
Value of net assets at end of year (total assets less liabilities)2015-12-31$-110,791
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$292,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Income. Interest from US Government securities2015-12-31$75
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$124,266
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$347,208
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$347,208
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$583,265
Asset value of US Government securities at end of year2015-12-31$206,772
Asset value of US Government securities at beginning of year2015-12-31$457,271
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$2,432,925
Employer contributions (assets) at beginning of year2015-12-31$134,447
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,577,008
Contract administrator fees2015-12-31$361,563
Liabilities. Value of benefit claims payable at end of year2015-12-31$525,960
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$671,904
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BROWN, EDWARDS & COMPANY, LLP
Accountancy firm EIN2015-12-31540504608
2014 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$756,475
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$786,561
Total income from all sources (including contributions)2014-12-31$4,397,841
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$4,176,399
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,738,473
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$4,397,755
Value of total assets at end of year2014-12-31$1,049,006
Value of total assets at beginning of year2014-12-31$857,650
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$437,926
Total interest from all sources2014-12-31$86
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$15,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,757,991
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$110,080
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$7
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$81,220
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$95,996
Administrative expenses (other) incurred2014-12-31$69,819
Liabilities. Value of operating payables at end of year2014-12-31$3,351
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$221,442
Value of net assets at end of year (total assets less liabilities)2014-12-31$292,531
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$71,089
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Income. Interest from US Government securities2014-12-31$86
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$347,208
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$583,692
Asset value of US Government securities at end of year2014-12-31$457,271
Asset value of US Government securities at beginning of year2014-12-31$857,643
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,639,764
Employer contributions (assets) at end of year2014-12-31$134,447
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,154,781
Contract administrator fees2014-12-31$368,107
Liabilities. Value of benefit claims payable at end of year2014-12-31$671,904
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$690,565
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BROWN, EDWARDS & COMPANY, LLP
Accountancy firm EIN2014-12-31540504608
2013 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$786,561
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$383,265
Total income from all sources (including contributions)2013-12-31$4,580,775
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$4,927,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$4,617,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$4,424,262
Value of total assets at end of year2013-12-31$857,650
Value of total assets at beginning of year2013-12-31$801,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$309,674
Total interest from all sources2013-12-31$82
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$15,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,862,842
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$7
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$7
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$95,996
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$93,621
Other income not declared elsewhere2013-12-31$156,431
Administrative expenses (other) incurred2013-12-31$4,704
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-346,761
Value of net assets at end of year (total assets less liabilities)2013-12-31$71,089
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$417,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Income. Interest from US Government securities2013-12-31$82
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$722,686
Asset value of US Government securities at end of year2013-12-31$857,643
Asset value of US Government securities at beginning of year2013-12-31$801,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,561,420
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$3,895,176
Contract administrator fees2013-12-31$304,970
Liabilities. Value of benefit claims payable at end of year2013-12-31$690,565
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$289,644
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31BROWN, EDWARDS & COMPANY, L.L.P.
Accountancy firm EIN2013-12-31540504608
2012 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$383,265
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$499,013
Total income from all sources (including contributions)2012-12-31$4,325,058
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$3,709,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,466,778
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$4,129,331
Value of total assets at end of year2012-12-31$801,115
Value of total assets at beginning of year2012-12-31$301,577
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$242,994
Total interest from all sources2012-12-31$59
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$15,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,611,309
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$7
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$1
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$93,621
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$84,799
Other income not declared elsewhere2012-12-31$195,668
Administrative expenses (other) incurred2012-12-31$761
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$615,286
Value of net assets at end of year (total assets less liabilities)2012-12-31$417,850
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$-197,436
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Income. Interest from US Government securities2012-12-31$59
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$634,667
Asset value of US Government securities at end of year2012-12-31$801,108
Asset value of US Government securities at beginning of year2012-12-31$301,576
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$2,518,022
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,832,111
Contract administrator fees2012-12-31$242,233
Liabilities. Value of benefit claims payable at end of year2012-12-31$289,644
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$414,214
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31BROWN, EDWARDS & COMPANY L.L.P.
Accountancy firm EIN2012-12-31540504608
2011 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$499,013
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$747,298
Total income from all sources (including contributions)2011-12-31$5,124,005
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$5,203,178
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$4,888,818
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$4,983,213
Value of total assets at end of year2011-12-31$301,576
Value of total assets at beginning of year2011-12-31$629,034
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$314,360
Total interest from all sources2011-12-31$22
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$15,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,648,187
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$7
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$84,799
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$360,662
Other income not declared elsewhere2011-12-31$140,770
Administrative expenses (other) incurred2011-12-31$15,628
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-79,173
Value of net assets at end of year (total assets less liabilities)2011-12-31$-197,437
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$-118,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Income. Interest from US Government securities2011-12-31$22
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$587,542
Asset value of US Government securities at end of year2011-12-31$301,576
Asset value of US Government securities at beginning of year2011-12-31$610,982
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$3,335,026
Employer contributions (assets) at beginning of year2011-12-31$18,045
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$4,301,276
Contract administrator fees2011-12-31$298,732
Liabilities. Value of benefit claims payable at end of year2011-12-31$414,214
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$386,636
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31BROWN, EDWARDS & COMPANY, L.L.P.
Accountancy firm EIN2011-12-31540504608
2010 : FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$747,298
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$479,727
Total income from all sources (including contributions)2010-12-31$4,270,582
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$4,544,970
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$4,050,350
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$4,255,413
Value of total assets at end of year2010-12-31$629,034
Value of total assets at beginning of year2010-12-31$635,851
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$494,620
Total interest from all sources2010-12-31$63
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$15,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$1,748,724
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$7
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$16
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$360,662
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$172,088
Other income not declared elsewhere2010-12-31$15,106
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-274,388
Value of net assets at end of year (total assets less liabilities)2010-12-31$-118,264
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$156,124
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Income. Interest from US Government securities2010-12-31$63
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$578,594
Asset value of US Government securities at end of year2010-12-31$610,982
Asset value of US Government securities at beginning of year2010-12-31$635,835
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,506,689
Employer contributions (assets) at end of year2010-12-31$18,045
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$3,471,756
Contract administrator fees2010-12-31$494,620
Liabilities. Value of benefit claims payable at end of year2010-12-31$386,636
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$307,639
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31BROWN, EDWARDS & COMPANY, L.L.P.
Accountancy firm EIN2010-12-31540504608

Form 5500 Responses for FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN

2022: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: FIRST COMMUNITY BANCSHARES, INC. MEDICAL & DENTAL CARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number97254
Policy instance 3
Insurance contract or identification number97254
Number of Individuals Covered73
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,082
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 $30,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,082
Insurance broker organization code?3
Other welfare benefits providedHOSPITAL INDEMNITY
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered274
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $16,923
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER/CRITICAL/HEART/STROKE
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 $85,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,219
Insurance broker organization code?3
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number47-MSL-000428-0
Policy instance 1
Insurance contract or identification number47-MSL-000428-0
Number of Individuals Covered468
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 $984,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered122
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $43,407
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER/CRITICAL/HEART/STROKE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,734
Insurance broker organization code?3
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number47-MSL-000428-0
Policy instance 1
Insurance contract or identification number47-MSL-000428-0
Number of Individuals Covered463
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,026,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number403392
Policy instance 3
Insurance contract or identification number403392
Number of Individuals Covered463
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,299,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered55
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $347
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER/HEART STROKE/ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $17,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $240
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered304
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,445
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $91,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,839
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered304
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,058
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $90,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,250
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered60
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $416
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER/HEART STROKE
Welfare Benefit Premiums Paid to CarrierUSD $20,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $274
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number403392
Policy instance 3
Insurance contract or identification number403392
Number of Individuals Covered383
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $982,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number403392
Policy instance 3
Insurance contract or identification number403392
Number of Individuals Covered820
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $866,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered78
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $566
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $291
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered286
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,384
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $100,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,009
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number403392
Policy instance 3
Insurance contract or identification number403392
Number of Individuals Covered866
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $609,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameHEALTHGRAM INC.
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered36
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $832
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $533
Insurance broker organization code?3
Insurance broker nameROBERT ASHLEY
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered283
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $16,023
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $104,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,784
Insurance broker organization code?3
Insurance broker nameELIZABETH CUSHING
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered248
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $33,738
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $125,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,215
Insurance broker organization code?3
Insurance broker nameKATHRYN H MORGAN
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered47
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $3,936
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $29,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,264
Insurance broker organization code?3
Insurance broker nameWILLIAM E. CAMPBELL, JR
U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number15163
Policy instance 4
Insurance contract or identification number15163
Number of Individuals Covered785
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 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 $14,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000019877
Policy instance 1
Insurance contract or identification number0000019877
Number of Individuals Covered234
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $58,524
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $88,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153
Insurance broker organization code?3
Insurance broker nameTREVOR G MURBACH
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered50
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,106
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $30,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,339
Insurance broker organization code?3
Insurance broker nameWILLIAM E CAMPBELL
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberGK758
Policy instance 1
Insurance contract or identification numberGK758
Number of Individuals Covered222
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $33,319
Total amount of fees paid to insurance companyUSD $8
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $191,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,279
Insurance broker organization code?3
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameJAMES M BROCK
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered57
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,884
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $33,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,645
Insurance broker organization code?3
Insurance broker nameJAMES E PERKINS
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered63
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,166
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $35,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,447
Insurance broker organization code?3
Insurance broker nameJAMES E PERKINS
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberGK758
Policy instance 1
Insurance contract or identification numberGK758
Number of Individuals Covered266
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $26,854
Total amount of fees paid to insurance companyUSD $603
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $117,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,006
Amount paid for insurance broker fees95
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLORRAINE MALO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered77
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,276
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $53,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberGK758
Policy instance 1
Insurance contract or identification numberGK758
Number of Individuals Covered188
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $11,726
Total amount of fees paid to insurance companyUSD $621
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $83,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberGK758
Policy instance 1
Insurance contract or identification numberGK758
Number of Individuals Covered150
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $16,366
Total amount of fees paid to insurance companyUSD $107
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
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 $97,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54822
Policy instance 2
Insurance contract or identification number54822
Number of Individuals Covered81
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,343
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $40,897
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 number01325,01326
Policy instance 3
Insurance contract or identification number01325,01326
Number of Individuals Covered586
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $34,630
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 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 $409,373
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 number001325
Policy instance 4
Insurance contract or identification number001325
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 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?Yes

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