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MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 401k Plan overview

Plan NameMITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN
Plan identification number 801

MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Other welfare benefit cover

401k Sponsoring company profile

MITCHELL ELECTRIC MEMBERSHIP CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:MITCHELL ELECTRIC MEMBERSHIP CORPORATION
Employer identification number (EIN):580353974
NAIC Classification:221100

Additional information about MITCHELL ELECTRIC MEMBERSHIP CORPORATION

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 504075

More information about MITCHELL ELECTRIC MEMBERSHIP CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
8012022-01-01
8012021-01-01
8012020-01-01
8012019-01-01
8012018-01-01
8012017-01-01TONY TUCKER
8012016-01-01TONY TUCKER
8012015-01-01TONY TUCKER
8012014-01-01TONY TUCKER
8012013-01-01TONY TUCKER
8012012-01-01TONY F TUCKER TONY TUCKER2013-07-12
8012011-01-01TONY F. TUCKER
8012009-01-01EDWARD A. PRITCHETT

Plan Statistics for MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN

401k plan membership statisitcs for MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN

Measure Date Value
2022: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01124
Total number of active participants reported on line 7a of the Form 55002022-01-01132
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01132
2021: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01120
Total number of active participants reported on line 7a of the Form 55002021-01-01124
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01124
2020: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01123
Total number of active participants reported on line 7a of the Form 55002020-01-01120
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01120
2019: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01123
Total number of active participants reported on line 7a of the Form 55002019-01-01123
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01123
2018: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01131
Total number of active participants reported on line 7a of the Form 55002018-01-01123
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01123
2017: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01138
Total number of active participants reported on line 7a of the Form 55002017-01-01131
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01131
2016: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0198
Total number of active participants reported on line 7a of the Form 55002016-01-01138
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01138
2015: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01134
Total number of active participants reported on line 7a of the Form 55002015-01-0198
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0198
2014: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-010
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-010
2013: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01155
Total of all active and inactive participants2013-01-010
2012: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01113
Total number of active participants reported on line 7a of the Form 55002012-01-01114
Total of all active and inactive participants2012-01-01114
2011: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01149
Total number of active participants reported on line 7a of the Form 55002011-01-01113
Total of all active and inactive participants2011-01-01113
2009: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0195
Total of all active and inactive participants2009-01-010

Financial Data on MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN

Measure Date Value
2022 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2022 401k financial data
Total income from all sources2022-12-31$0
Total plan assets at end of year2022-12-31$0
Total plan assets at beginning of year2022-12-31$0
Net plan assets at end of year (total assets less liabilities)2022-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$0
2021 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2021 401k financial data
Total income from all sources2021-12-31$0
Total plan assets at end of year2021-12-31$0
Total plan assets at beginning of year2021-12-31$0
Net plan assets at end of year (total assets less liabilities)2021-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$0
2020 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2020 401k financial data
Total income from all sources2020-12-31$0
Total plan assets at end of year2020-12-31$0
Total plan assets at beginning of year2020-12-31$0
Net plan assets at end of year (total assets less liabilities)2020-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$0
2019 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2019 401k financial data
Total income from all sources2019-12-31$0
Total plan assets at end of year2019-12-31$0
Total plan assets at beginning of year2019-12-31$0
Net plan assets at end of year (total assets less liabilities)2019-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$0
2018 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2018 401k financial data
Total income from all sources2018-12-31$0
Total plan assets at end of year2018-12-31$0
Total plan assets at beginning of year2018-12-31$0
Net plan assets at end of year (total assets less liabilities)2018-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$0
2017 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2017 401k financial data
Total income from all sources2017-12-31$0
Total plan assets at end of year2017-12-31$0
Total plan assets at beginning of year2017-12-31$0
Net plan assets at end of year (total assets less liabilities)2017-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$0
2016 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2016 401k financial data
Total income from all sources2016-12-31$0
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$0
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
2015 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2015 401k financial data
Total income from all sources2015-12-31$0
Total plan assets at end of year2015-12-31$0
Total plan assets at beginning of year2015-12-31$0
Net plan assets at end of year (total assets less liabilities)2015-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$0
2014 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2014 401k financial data
Total income from all sources2014-12-31$0
Total plan assets at end of year2014-12-31$0
Total plan assets at beginning of year2014-12-31$0
Net plan assets at end of year (total assets less liabilities)2014-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
2013 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2013 401k financial data
Total income from all sources2013-12-31$0
Total plan assets at end of year2013-12-31$0
Total plan assets at beginning of year2013-12-31$0
Net plan assets at end of year (total assets less liabilities)2013-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0
2012 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2012 401k financial data
Total income from all sources2012-12-31$0
Total plan assets at end of year2012-12-31$0
Total plan assets at beginning of year2012-12-31$0
Net plan assets at end of year (total assets less liabilities)2012-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
2011 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2011 401k financial data
Total income from all sources2011-12-31$0
Total plan assets at end of year2011-12-31$0
Total plan assets at beginning of year2011-12-31$0
Net plan assets at end of year (total assets less liabilities)2011-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
2010 : MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2010 401k financial data
Total plan assets at end of year2010-12-31$0
Net plan assets at end of year (total assets less liabilities)2010-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$0

Form 5500 Responses for MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN

2022: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MITCHELL ELECTRIC MEMBERSHIP CORPORATION LONG TERM CARE INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1084814
Policy instance 3
Insurance contract or identification number1084814
Number of Individuals Covered132
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,300
Are there contracts with allocated funds for individual policies?1
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,300
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 2
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered60
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $14,852
Are there contracts with allocated funds for individual policies?1
Contracts With Unallocated Funds Deposit Administration1
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,852
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 1
Insurance contract or identification number000000580725
Number of Individuals Covered101
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $7,919
Are there contracts with allocated funds for individual policies?1
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,919
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 1
Insurance contract or identification number000000580725
Number of Individuals Covered96
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $7,020
Are there contracts with allocated funds for individual policies?1
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,020
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 2
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered60
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,798
Are there contracts with allocated funds for individual policies?1
Contracts With Unallocated Funds Deposit Administration1
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,798
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1084814
Policy instance 3
Insurance contract or identification number1084814
Number of Individuals Covered124
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,915
Are there contracts with allocated funds for individual policies?1
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,915
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1084814
Policy instance 3
Insurance contract or identification number1084814
Number of Individuals Covered120
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,774
Are there contracts with allocated funds for individual policies?1
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,774
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 2
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered61
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,080
Are there contracts with allocated funds for individual policies?1
Contracts With Unallocated Funds Deposit Administration1
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,830
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 1
Insurance contract or identification number000000580725
Number of Individuals Covered94
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $7,418
Are there contracts with allocated funds for individual policies?1
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,418
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 1
Insurance contract or identification number000000580725
Number of Individuals Covered111
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $6,688
Are there contracts with allocated funds for individual policies?1
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,688
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1084814
Policy instance 3
Insurance contract or identification number1084814
Number of Individuals Covered123
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,192
Are there contracts with allocated funds for individual policies?1
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,192
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 2
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered62
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $15,095
Are there contracts with allocated funds for individual policies?1
Contracts With Unallocated Funds Deposit Administration1
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,095
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered131
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,099
Are there contracts with allocated funds for individual policies?1
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,099
Insurance broker nameCAMILLA INSURANCE & INVESTMENTS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered59
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,646
Are there contracts with allocated funds for individual policies?1
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,646
Insurance broker namePHILIP SAUSSY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered44
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,658
Are there contracts with allocated funds for individual policies?1
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,658
Insurance broker nameJOY L POLLOCK
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-035130
Policy instance 1
Insurance contract or identification number010-035130
Number of Individuals Covered70
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $429
Are there contracts with allocated funds for individual policies?1
Other welfare benefits providedVISON
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $429
Insurance broker nameCAMILLA INS & INVESTMENTS INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered98
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,973
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,973
Additional information about fees paid to insurance brokerDENTAL INSURANCE N/A
Insurance broker nameCAMILLA INSURANCE & INVESTMENTS
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered61
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $455
Total amount of fees paid to insurance companyUSD $23
Other welfare benefits providedVISON
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $455
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerVISON N/A
Insurance broker nameCAMILLA INS & INVESTMETNS INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered91
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,810
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,810
Additional information about fees paid to insurance brokerGROUP TERM 3
Insurance broker nameJOY L POLLOCK
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered60
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $11,036
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,036
Additional information about fees paid to insurance brokerGROUP BENEFITS N/A
Insurance broker namePHILIP SAUSSY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered60
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,036
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,036
Additional information about fees paid to insurance brokerGROUP BENEFITS N/A
Insurance broker namePHILIP SAUSSY
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered63
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $434
Other welfare benefits providedVISON
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $434
Additional information about fees paid to insurance brokerVISON N/A
Insurance broker nameCAMILLA INS & INVESTMETNS INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered92
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,374
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,374
Additional information about fees paid to insurance brokerGROUP TERM 3
Insurance broker nameEMPLOYES ASSOCIATED INS.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered134
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,967
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,967
Additional information about fees paid to insurance brokerDENTAL INSURANCE N/A
Insurance broker nameCAMILLA INSURANCE & INVESTMENTS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered87
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,126
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,126
Additional information about fees paid to insurance brokerGROUP TERM 3
Insurance broker nameEMPLOYES ASSOCIATED INS.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered62
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,267
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,267
Additional information about fees paid to insurance brokerGROUP BENEFITS N/A
Insurance broker namePHILIP SAUSSY
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered155
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,072
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,072
Additional information about fees paid to insurance brokerDENTAL INSURANCE N/A
Insurance broker nameCAMILLA INSURANCE & INVESTMENTS
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered61
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $890
Total amount of fees paid to insurance companyUSD $106
Other welfare benefits providedVISON
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $890
Amount paid for insurance broker fees106
Additional information about fees paid to insurance brokerVISON N/A
Insurance broker nameCAMILLA INS & INVESTMETNS INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered114
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,409
Additional information about fees paid to insurance brokerDENTAL INSURANCE N/A
Insurance broker nameCAMILLA INSUANCE & INVESTMENTS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered3
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,579
Other welfare benefits providedLONG TERM CARE INSURANCE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,579
Additional information about fees paid to insurance brokerN/A N/A
Insurance broker nameJ SMITH LANIER & CO
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Number of Individuals Covered58
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $10,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,921
Additional information about fees paid to insurance brokerGROUP BENEFITS N/A
Insurance broker namePHILIP SAUSSY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered100
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,131
Additional information about fees paid to insurance brokerGROUP TERM 3
Insurance broker nameEMPLOYES ASSOCIATED INS.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered87
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,609
Other welfare benefits providedLONG TERM CARE INSURANCE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 2
Insurance contract or identification number000000580725
Number of Individuals Covered95
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 3
Insurance contract or identification numberAGP-003203-69
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 4
Insurance contract or identification numberTM05711781
Number of Individuals Covered149
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000580725
Policy instance 3
Insurance contract or identification number000000580725
Number of Individuals Covered95
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,313
Additional information about fees paid to insurance brokerGROUP TERM
Insurance broker organization code?3
Insurance broker nameJOY L POLLOCK
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-003203-69
Policy instance 4
Insurance contract or identification numberAGP-003203-69
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,252
Additional information about fees paid to insurance brokerGROUP BENEFITS
Insurance broker organization code?3
Insurance broker namePHILIP SAUSSY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number142290
Policy instance 1
Insurance contract or identification number142290
Number of Individuals Covered87
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,873
Other welfare benefits providedLONG TERM CARE INSURANCE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,873
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameJ SMITH LANIER & CO
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05711781
Policy instance 5
Insurance contract or identification numberTM05711781
Number of Individuals Covered149
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,156
Additional information about fees paid to insurance brokerDENTAL INSURANCE
Insurance broker organization code?3
Insurance broker nameCAMILLA INSUANCE & INVESTMENTS
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number1021388000
Policy instance 2
Insurance contract or identification number1021388000
Number of Individuals Covered101
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,208
Total amount of fees paid to insurance companyUSD $3,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,208
Amount paid for insurance broker fees3190
Additional information about fees paid to insurance brokerHEALTH INSURANCE
Insurance broker organization code?3
Insurance broker nameJ. SMITH LANIER & CO

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