401k Plan data: FIRST SOUTH BANK WELFARE BENEFIT PLAN plan

FIRST SOUTH BANK WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	FIRST SOUTH BANK WELFARE BENEFIT PLAN
Plan identification number	501

FIRST SOUTH BANK WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

FIRST SOUTH BANK has sponsored the creation of one or more 401k plans.

Company Name: FIRST SOUTH BANK

Employer identification number (EIN): 560266599

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST SOUTH BANK WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-09-01 EMILY HUDSON
501 2016-09-01 EMILY HUDSON
501 2015-09-01 NICOLE HAM
501 2014-09-01 NICOLE HAM
501 2013-09-01 NICOLE HAM
501 2012-09-01 NICOLE SPENCE
501 2011-09-01 NICOLE SPENCE
501 2009-09-01 NICOLE SPENCE
501 2008-09-01 NICOLE SPENCE
501 2007-09-01 NICOLE SPENCE
501 2006-09-01 NICOLE SPENCE
501 2005-09-01 NICOLE SPENCE
501 2004-09-01 NICOLE SPENCE

Plan id#	Filing Submission Date	Name of Administrator
501	2017-09-01	EMILY HUDSON
501	2016-09-01	EMILY HUDSON
501	2015-09-01	NICOLE HAM
501	2014-09-01	NICOLE HAM
501	2013-09-01	NICOLE HAM
501	2012-09-01	NICOLE SPENCE
501	2011-09-01	NICOLE SPENCE
501	2009-09-01	NICOLE SPENCE
501	2008-09-01	NICOLE SPENCE
501	2007-09-01	NICOLE SPENCE
501	2006-09-01	NICOLE SPENCE
501	2005-09-01	NICOLE SPENCE
501	2004-09-01	NICOLE SPENCE

Plan Statistics for FIRST SOUTH BANK WELFARE BENEFIT PLAN

401k plan membership statisitcs for FIRST SOUTH BANK WELFARE BENEFIT PLAN

Measure Date Value
2017: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 242
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 215
Number of retired or separated participants receiving benefits 2017-09-01 3
Number of other retired or separated participants entitled to future benefits 2017-09-01 13
Total of all active and inactive participants 2017-09-01 231
Total participants 2017-09-01 231
2016: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 249
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 223
Number of retired or separated participants receiving benefits 2016-09-01 4
Number of other retired or separated participants entitled to future benefits 2016-09-01 12
Total of all active and inactive participants 2016-09-01 239
2015: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 322
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 281
Number of retired or separated participants receiving benefits 2015-09-01 6
Number of other retired or separated participants entitled to future benefits 2015-09-01 15
Total of all active and inactive participants 2015-09-01 302
2014: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 240
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 308
Number of retired or separated participants receiving benefits 2014-09-01 6
Number of other retired or separated participants entitled to future benefits 2014-09-01 12
Total of all active and inactive participants 2014-09-01 326
2013: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 239
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 236
Number of retired or separated participants receiving benefits 2013-09-01 5
Number of other retired or separated participants entitled to future benefits 2013-09-01 9
Total of all active and inactive participants 2013-09-01 250
2012: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 229
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 239
Number of retired or separated participants receiving benefits 2012-09-01 10
Number of other retired or separated participants entitled to future benefits 2012-09-01 8
Total of all active and inactive participants 2012-09-01 257
2011: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 232
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 220
Number of retired or separated participants receiving benefits 2011-09-01 5
Total of all active and inactive participants 2011-09-01 225
Total participants 2011-09-01 225
2009: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 264
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 264
Number of retired or separated participants receiving benefits 2009-09-01 10
Number of other retired or separated participants entitled to future benefits 2009-09-01 0
Total of all active and inactive participants 2009-09-01 274
2008: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-09-01 272
Total number of active participants reported on line 7a of the Form 5500 2008-09-01 279
Number of retired or separated participants receiving benefits 2008-09-01 0
Number of other retired or separated participants entitled to future benefits 2008-09-01 0
Total of all active and inactive participants 2008-09-01 279
2007: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year 2007-09-01 264
Total number of active participants reported on line 7a of the Form 5500 2007-09-01 272
Number of retired or separated participants receiving benefits 2007-09-01 0
Number of other retired or separated participants entitled to future benefits 2007-09-01 0
Total of all active and inactive participants 2007-09-01 272
2006: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year 2006-09-01 253
Total number of active participants reported on line 7a of the Form 5500 2006-09-01 264
Number of retired or separated participants receiving benefits 2006-09-01 0
Number of other retired or separated participants entitled to future benefits 2006-09-01 0
Total of all active and inactive participants 2006-09-01 264
2005: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year 2005-09-01 252
Total number of active participants reported on line 7a of the Form 5500 2005-09-01 253
Number of retired or separated participants receiving benefits 2005-09-01 0
Number of other retired or separated participants entitled to future benefits 2005-09-01 0
Total of all active and inactive participants 2005-09-01 253
2004: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year 2004-09-01 227
Total number of active participants reported on line 7a of the Form 5500 2004-09-01 252
Number of retired or separated participants receiving benefits 2004-09-01 0
Number of other retired or separated participants entitled to future benefits 2004-09-01 0
Total of all active and inactive participants 2004-09-01 252

Measure	Date	Value
2017: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	242
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	215
Number of retired or separated participants receiving benefits	2017-09-01	3
Number of other retired or separated participants entitled to future benefits	2017-09-01	13
Total of all active and inactive participants	2017-09-01	231
Total participants	2017-09-01	231
2016: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	249
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	223
Number of retired or separated participants receiving benefits	2016-09-01	4
Number of other retired or separated participants entitled to future benefits	2016-09-01	12
Total of all active and inactive participants	2016-09-01	239
2015: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	322
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	281
Number of retired or separated participants receiving benefits	2015-09-01	6
Number of other retired or separated participants entitled to future benefits	2015-09-01	15
Total of all active and inactive participants	2015-09-01	302
2014: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	240
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	308
Number of retired or separated participants receiving benefits	2014-09-01	6
Number of other retired or separated participants entitled to future benefits	2014-09-01	12
Total of all active and inactive participants	2014-09-01	326
2013: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	239
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	236
Number of retired or separated participants receiving benefits	2013-09-01	5
Number of other retired or separated participants entitled to future benefits	2013-09-01	9
Total of all active and inactive participants	2013-09-01	250
2012: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	229
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	239
Number of retired or separated participants receiving benefits	2012-09-01	10
Number of other retired or separated participants entitled to future benefits	2012-09-01	8
Total of all active and inactive participants	2012-09-01	257
2011: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	232
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	220
Number of retired or separated participants receiving benefits	2011-09-01	5
Total of all active and inactive participants	2011-09-01	225
Total participants	2011-09-01	225
2009: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	264
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	264
Number of retired or separated participants receiving benefits	2009-09-01	10
Number of other retired or separated participants entitled to future benefits	2009-09-01	0
Total of all active and inactive participants	2009-09-01	274
2008: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-09-01	272
Total number of active participants reported on line 7a of the Form 5500	2008-09-01	279
Number of retired or separated participants receiving benefits	2008-09-01	0
Number of other retired or separated participants entitled to future benefits	2008-09-01	0
Total of all active and inactive participants	2008-09-01	279
2007: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-09-01	264
Total number of active participants reported on line 7a of the Form 5500	2007-09-01	272
Number of retired or separated participants receiving benefits	2007-09-01	0
Number of other retired or separated participants entitled to future benefits	2007-09-01	0
Total of all active and inactive participants	2007-09-01	272
2006: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-09-01	253
Total number of active participants reported on line 7a of the Form 5500	2006-09-01	264
Number of retired or separated participants receiving benefits	2006-09-01	0
Number of other retired or separated participants entitled to future benefits	2006-09-01	0
Total of all active and inactive participants	2006-09-01	264
2005: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-09-01	252
Total number of active participants reported on line 7a of the Form 5500	2005-09-01	253
Number of retired or separated participants receiving benefits	2005-09-01	0
Number of other retired or separated participants entitled to future benefits	2005-09-01	0
Total of all active and inactive participants	2005-09-01	253
2004: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year	2004-09-01	227
Total number of active participants reported on line 7a of the Form 5500	2004-09-01	252
Number of retired or separated participants receiving benefits	2004-09-01	0
Number of other retired or separated participants entitled to future benefits	2004-09-01	0
Total of all active and inactive participants	2004-09-01	252

Form 5500 Responses for FIRST SOUTH BANK WELFARE BENEFIT PLAN

2017: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2009: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2008: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-09-01	Type of plan entity	Single employer plan
2008-09-01	Submission has been amended	No
2008-09-01	This submission is the final filing	No
2008-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-09-01	Plan is a collectively bargained plan	No
2008-09-01	Plan funding arrangement – Insurance	Yes
2008-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-09-01	Plan benefit arrangement – Insurance	Yes
2008-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-09-01	Type of plan entity	Single employer plan
2007-09-01	Submission has been amended	No
2007-09-01	This submission is the final filing	No
2007-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-09-01	Plan is a collectively bargained plan	No
2007-09-01	Plan funding arrangement – Insurance	Yes
2007-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-09-01	Plan benefit arrangement – Insurance	Yes
2007-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-09-01	Type of plan entity	Single employer plan
2006-09-01	Submission has been amended	No
2006-09-01	This submission is the final filing	No
2006-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-09-01	Plan is a collectively bargained plan	No
2006-09-01	Plan funding arrangement – Insurance	Yes
2006-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-09-01	Plan benefit arrangement – Insurance	Yes
2006-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-09-01	Type of plan entity	Single employer plan
2005-09-01	Submission has been amended	No
2005-09-01	This submission is the final filing	No
2005-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-09-01	Plan is a collectively bargained plan	No
2005-09-01	Plan funding arrangement – Insurance	Yes
2005-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-09-01	Plan benefit arrangement – Insurance	Yes
2005-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: FIRST SOUTH BANK WELFARE BENEFIT PLAN 2004 form 5500 responses
2004-09-01	Type of plan entity	Single employer plan
2004-09-01	Submission has been amended	No
2004-09-01	This submission is the final filing	No
2004-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-09-01	Plan is a collectively bargained plan	No
2004-09-01	Plan funding arrangement – Insurance	Yes
2004-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-09-01	Plan benefit arrangement – Insurance	Yes
2004-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	04086
Policy instance	3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1046447
Policy instance	2
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number	213300
Policy instance	1
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1046447
Policy instance	2
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number	213300
Policy instance	1
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	04086
Policy instance	3
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number	213300
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05911594
Policy instance	2
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number	213300
Policy instance	1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00479244
Policy instance	2
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract number	893266-000
Policy instance	2
FIRSTCAROLINACARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number	213300
Policy instance	1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	G000104G
Policy instance	3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	G000104G
Policy instance	2
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract number	893266-000
Policy instance	1
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	1
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	G000104G
Policy instance	2
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	MG18556
Policy instance	3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	G000104G
Policy instance	2
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	MG18556
Policy instance	3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	1
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	MG18556
Policy instance	3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	G000104G
Policy instance	2
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	1
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	046-3015-00
Policy instance	2
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	MG18556
Policy instance	3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	MG18556
Policy instance	3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	046-3015-00
Policy instance	2
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number	008412
Policy instance	1

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Company Name:	FIRST SOUTH BANK
Employer identification number (EIN):	560266599
NAIC Classification:	522110
NAIC Description:	Commercial Banking