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VALLEY APPAREL LLC PREMIUM ONLY PLAN 401k Plan overview

Plan NameVALLEY APPAREL LLC PREMIUM ONLY PLAN
Plan identification number 501

VALLEY APPAREL LLC PREMIUM ONLY PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    VALLEY APPAREL, LLC has sponsored the creation of one or more 401k plans.

    Company Name:VALLEY APPAREL, LLC
    Employer identification number (EIN):621833356
    NAIC Classification:314000
    NAIC Description: Textile Product Mills

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan VALLEY APPAREL LLC PREMIUM ONLY PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012020-03-01
    5012019-03-01
    5012018-03-01
    5012017-03-01KEVIN MACLEAY KEVIN MACLEAY2018-07-11
    5012016-03-01KEVIN MACLEAY KEVIN MACLEAY2017-08-07
    5012015-03-01KEVIN MACLEAY KEVIN MACLEAY2016-09-21
    5012014-03-01KEVIN MACLEAY KEVIN MACLEAY2015-09-10
    5012013-03-01KEVIN MACLEAY KEVIN MACLEAY2014-08-13
    5012012-03-01KEVIN MACLEAY KEVIN MACLEAY2013-08-22
    5012011-03-01KEVIN MACLEAY
    5012010-03-01KEVIN MACLEAY
    5012009-03-01KEVIN MACLEAY KEVIN MACLEAY2010-07-19
    5012009-03-01 KEVIN MACLEAY2010-07-19

    Plan Statistics for VALLEY APPAREL LLC PREMIUM ONLY PLAN

    401k plan membership statisitcs for VALLEY APPAREL LLC PREMIUM ONLY PLAN

    Measure Date Value
    2020: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2020 401k membership
    Total participants, beginning-of-year2020-03-01253
    Total number of active participants reported on line 7a of the Form 55002020-03-01226
    Total of all active and inactive participants2020-03-01226
    Total participants2020-03-01226
    2019: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2019 401k membership
    Total participants, beginning-of-year2019-03-01251
    Total number of active participants reported on line 7a of the Form 55002019-03-01253
    Total of all active and inactive participants2019-03-01253
    Total participants2019-03-01253
    2018: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2018 401k membership
    Total participants, beginning-of-year2018-03-01261
    Total number of active participants reported on line 7a of the Form 55002018-03-01251
    Total of all active and inactive participants2018-03-01251
    Total participants2018-03-01251
    2017: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2017 401k membership
    Total participants, beginning-of-year2017-03-01259
    Total number of active participants reported on line 7a of the Form 55002017-03-01261
    Total of all active and inactive participants2017-03-01261
    Total participants2017-03-01261
    2016: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2016 401k membership
    Total participants, beginning-of-year2016-03-01225
    Total number of active participants reported on line 7a of the Form 55002016-03-01259
    Total of all active and inactive participants2016-03-01259
    Total participants2016-03-01259
    2015: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2015 401k membership
    Total participants, beginning-of-year2015-03-01206
    Total number of active participants reported on line 7a of the Form 55002015-03-01225
    Total of all active and inactive participants2015-03-01225
    Total participants2015-03-01225
    2014: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2014 401k membership
    Total participants, beginning-of-year2014-03-01224
    Total number of active participants reported on line 7a of the Form 55002014-03-01206
    Total of all active and inactive participants2014-03-01206
    Total participants2014-03-01206
    2013: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2013 401k membership
    Total participants, beginning-of-year2013-03-01287
    Total number of active participants reported on line 7a of the Form 55002013-03-01224
    Total of all active and inactive participants2013-03-01224
    Total participants2013-03-01224
    2012: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2012 401k membership
    Total participants, beginning-of-year2012-03-01246
    Total number of active participants reported on line 7a of the Form 55002012-03-01287
    Total of all active and inactive participants2012-03-01287
    Total participants2012-03-01287
    2011: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2011 401k membership
    Total participants, beginning-of-year2011-03-01301
    Total number of active participants reported on line 7a of the Form 55002011-03-01246
    Number of retired or separated participants receiving benefits2011-03-010
    Number of other retired or separated participants entitled to future benefits2011-03-010
    Total of all active and inactive participants2011-03-01246
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-03-010
    Total participants2011-03-01246
    2010: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2010 401k membership
    Total participants, beginning-of-year2010-03-01301
    Total number of active participants reported on line 7a of the Form 55002010-03-01301
    Total of all active and inactive participants2010-03-01301
    Total participants2010-03-01301
    2009: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2009 401k membership
    Total participants, beginning-of-year2009-03-01228
    Total number of active participants reported on line 7a of the Form 55002009-03-01301
    Total of all active and inactive participants2009-03-01301
    Total participants2009-03-01301

    Form 5500 Responses for VALLEY APPAREL LLC PREMIUM ONLY PLAN

    2020: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2020 form 5500 responses
    2020-03-01Type of plan entitySingle employer plan
    2020-03-01Submission has been amendedNo
    2020-03-01This submission is the final filingNo
    2020-03-01This return/report is a short plan year return/report (less than 12 months)No
    2020-03-01Plan is a collectively bargained planNo
    2020-03-01Plan funding arrangement – InsuranceYes
    2020-03-01Plan benefit arrangement – InsuranceYes
    2019: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2019 form 5500 responses
    2019-03-01Type of plan entitySingle employer plan
    2019-03-01Submission has been amendedNo
    2019-03-01This submission is the final filingNo
    2019-03-01This return/report is a short plan year return/report (less than 12 months)No
    2019-03-01Plan is a collectively bargained planNo
    2019-03-01Plan funding arrangement – InsuranceYes
    2019-03-01Plan benefit arrangement – InsuranceYes
    2018: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2018 form 5500 responses
    2018-03-01Type of plan entitySingle employer plan
    2018-03-01Submission has been amendedNo
    2018-03-01This submission is the final filingNo
    2018-03-01This return/report is a short plan year return/report (less than 12 months)No
    2018-03-01Plan is a collectively bargained planNo
    2018-03-01Plan funding arrangement – InsuranceYes
    2018-03-01Plan benefit arrangement – InsuranceYes
    2017: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2017 form 5500 responses
    2017-03-01Type of plan entitySingle employer plan
    2017-03-01Submission has been amendedNo
    2017-03-01This submission is the final filingNo
    2017-03-01This return/report is a short plan year return/report (less than 12 months)No
    2017-03-01Plan is a collectively bargained planNo
    2017-03-01Plan funding arrangement – InsuranceYes
    2017-03-01Plan benefit arrangement – InsuranceYes
    2016: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2016 form 5500 responses
    2016-03-01Type of plan entitySingle employer plan
    2016-03-01Submission has been amendedNo
    2016-03-01This submission is the final filingNo
    2016-03-01This return/report is a short plan year return/report (less than 12 months)No
    2016-03-01Plan is a collectively bargained planNo
    2016-03-01Plan funding arrangement – InsuranceYes
    2016-03-01Plan benefit arrangement – InsuranceYes
    2015: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2015 form 5500 responses
    2015-03-01Type of plan entitySingle employer plan
    2015-03-01Submission has been amendedNo
    2015-03-01This submission is the final filingNo
    2015-03-01This return/report is a short plan year return/report (less than 12 months)No
    2015-03-01Plan is a collectively bargained planNo
    2015-03-01Plan funding arrangement – InsuranceYes
    2015-03-01Plan benefit arrangement – InsuranceYes
    2014: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2014 form 5500 responses
    2014-03-01Type of plan entitySingle employer plan
    2014-03-01Submission has been amendedNo
    2014-03-01This submission is the final filingNo
    2014-03-01This return/report is a short plan year return/report (less than 12 months)No
    2014-03-01Plan is a collectively bargained planNo
    2014-03-01Plan funding arrangement – InsuranceYes
    2014-03-01Plan benefit arrangement – InsuranceYes
    2013: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2013 form 5500 responses
    2013-03-01Type of plan entitySingle employer plan
    2013-03-01Submission has been amendedNo
    2013-03-01This submission is the final filingNo
    2013-03-01This return/report is a short plan year return/report (less than 12 months)No
    2013-03-01Plan is a collectively bargained planNo
    2013-03-01Plan funding arrangement – InsuranceYes
    2013-03-01Plan benefit arrangement – InsuranceYes
    2012: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2012 form 5500 responses
    2012-03-01Type of plan entitySingle employer plan
    2012-03-01Submission has been amendedNo
    2012-03-01This submission is the final filingNo
    2012-03-01This return/report is a short plan year return/report (less than 12 months)No
    2012-03-01Plan is a collectively bargained planNo
    2012-03-01Plan funding arrangement – InsuranceYes
    2012-03-01Plan benefit arrangement – InsuranceYes
    2011: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2011 form 5500 responses
    2011-03-01Type of plan entitySingle employer plan
    2011-03-01Submission has been amendedNo
    2011-03-01This submission is the final filingNo
    2011-03-01This return/report is a short plan year return/report (less than 12 months)No
    2011-03-01Plan is a collectively bargained planNo
    2011-03-01Plan funding arrangement – InsuranceYes
    2011-03-01Plan benefit arrangement – InsuranceYes
    2010: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2010 form 5500 responses
    2010-03-01Type of plan entitySingle employer plan
    2010-03-01Submission has been amendedYes
    2010-03-01This submission is the final filingNo
    2010-03-01This return/report is a short plan year return/report (less than 12 months)No
    2010-03-01Plan is a collectively bargained planNo
    2010-03-01Plan funding arrangement – InsuranceYes
    2010-03-01Plan benefit arrangement – InsuranceYes
    2009: VALLEY APPAREL LLC PREMIUM ONLY PLAN 2009 form 5500 responses
    2009-03-01Type of plan entitySingle employer plan
    2009-03-01Submission has been amendedYes
    2009-03-01This submission is the final filingNo
    2009-03-01This return/report is a short plan year return/report (less than 12 months)No
    2009-03-01Plan is a collectively bargained planNo
    2009-03-01Plan funding arrangement – InsuranceYes
    2009-03-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number799500
    Policy instance 1
    Insurance contract or identification number799500
    Number of Individuals Covered148
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $40,344
    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 $1,342,443
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $40,344
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 5
    Insurance contract or identification number50017721
    Number of Individuals Covered100
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $7,075
    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
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $23,583
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,537
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 4
    Insurance contract or identification number50017721
    Number of Individuals Covered70
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $765
    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
    Other welfare benefits providedVOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,552
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $383
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered226
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $2,368
    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
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $10,735
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,074
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 2
    Insurance contract or identification number127720
    Number of Individuals Covered188
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $5,090
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare 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 $15,461
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,090
    Additional information about fees paid to insurance brokerACQ/REF
    Insurance broker organization code?3
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 6
    Insurance contract or identification numberV8092
    Number of Individuals Covered132
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $16,965
    Total amount of fees paid to insurance companyUSD $790
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $92,668
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,815
    Amount paid for insurance broker fees348
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 1
    Insurance contract or identification number50017721
    Number of Individuals Covered253
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $2,182
    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
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT & GROUP TERM LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $11,603
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,224
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 5
    Insurance contract or identification number127720
    Number of Individuals Covered198
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $5,129
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare 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 $15,584
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,129
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 4
    Insurance contract or identification numberV8092
    Number of Individuals Covered143
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $20,189
    Total amount of fees paid to insurance companyUSD $665
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $89,972
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2
    Insurance broker organization code?3
    Amount paid for insurance broker fees95
    Additional information about fees paid to insurance brokerFEES
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered108
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $5,686
    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
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $22,539
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,843
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number799500
    Policy instance 6
    Insurance contract or identification number799500
    Number of Individuals Covered155
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $36,825
    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 $1,327,787
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $36,825
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 2
    Insurance contract or identification number50017721
    Number of Individuals Covered76
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $652
    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
    Other welfare benefits providedVOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,589
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $326
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 1
    Insurance contract or identification number50017721
    Number of Individuals Covered77
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $761
    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
    Other welfare benefits providedVOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,420
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $398
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 5
    Insurance contract or identification number50017721
    Number of Individuals Covered251
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $2,645
    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
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 $11,425
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,309
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered110
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $7,576
    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
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $24,108
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,960
    Insurance broker organization code?3
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 4
    Insurance contract or identification numberV8092
    Number of Individuals Covered140
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $16,324
    Total amount of fees paid to insurance companyUSD $432
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $84,317
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2
    Insurance broker organization code?3
    Amount paid for insurance broker fees62
    Additional information about fees paid to insurance brokerFEES
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 2
    Insurance contract or identification number127720
    Number of Individuals Covered202
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $4,816
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare 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 $15,375
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,816
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number799500
    Policy instance 6
    Insurance contract or identification number799500
    Number of Individuals Covered157
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Total amount of commissions paid to insurance brokerUSD $41,496
    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 $1,318,781
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $39,521
    Insurance broker organization code?3
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 1
    Insurance contract or identification number127720
    Number of Individuals Covered237
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Total amount of commissions paid to insurance brokerUSD $42,552
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,123
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $42,552
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameANDREW RADER
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 2
    Insurance contract or identification number50017721
    Number of Individuals Covered261
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Total amount of commissions paid to insurance brokerUSD $2,469
    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 providedACCIDENTAL DEATH & DISMEMBERMENT
    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 $11,368
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,137
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 4
    Insurance contract or identification number50017721
    Number of Individuals Covered120
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Total amount of commissions paid to insurance brokerUSD $7,406
    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
    Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $24,662
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees7
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $3,699
    Insurance broker nameGROUP INSURANCE SERVICES INC
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 5
    Insurance contract or identification numberV8092
    Number of Individuals Covered113
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Total amount of commissions paid to insurance brokerUSD $15,189
    Total amount of fees paid to insurance companyUSD $515
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $82,282
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2
    Insurance broker organization code?3
    Amount paid for insurance broker fees18
    Insurance broker nameSUSIE C THORPE
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered77
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Total amount of commissions paid to insurance brokerUSD $705
    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
    Other welfare benefits providedVOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,348
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees1
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $352
    Insurance broker nameGROUP INSURANCE SERVICES INC
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 5
    Insurance contract or identification numberV8092
    Number of Individuals Covered95
    Insurance policy start date2015-03-01
    Insurance policy end date2016-02-28
    Total amount of commissions paid to insurance brokerUSD $10,869
    Total amount of fees paid to insurance companyUSD $182
    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 $55,977
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3
    Insurance broker organization code?3
    Amount paid for insurance broker fees19
    Insurance broker nameSUSIE C. THORPE
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 1
    Insurance contract or identification number127720
    Number of Individuals Covered249
    Insurance policy start date2015-03-01
    Insurance policy end date2016-02-28
    Total amount of commissions paid to insurance brokerUSD $59,487
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $15,530
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $59,487
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameLISA HELTON
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 2
    Insurance contract or identification number50017721
    Number of Individuals Covered64
    Insurance policy start date2015-03-01
    Insurance policy end date2016-02-28
    Total amount of commissions paid to insurance brokerUSD $618
    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 providedVOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,058
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $309
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES, INC.
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered225
    Insurance policy start date2015-03-01
    Insurance policy end date2016-02-28
    Total amount of commissions paid to insurance brokerUSD $2,388
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 $10,860
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,086
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC.
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 4
    Insurance contract or identification number50017721
    Number of Individuals Covered120
    Insurance policy start date2015-03-01
    Insurance policy end date2016-02-28
    Total amount of commissions paid to insurance brokerUSD $5,872
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare 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 $19,575
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,936
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC.
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 5
    Insurance contract or identification number50017721
    Number of Individuals Covered123
    Insurance policy start date2014-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $5,644
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare 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 $18,812
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,822
    Insurance broker organization code?3
    Insurance broker nameSHAFER INSURANCE AGENCY INC
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered206
    Insurance policy start date2014-03-01
    Insurance policy end date2015-02-28
    Total amount of commissions paid to insurance brokerUSD $2,048
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare 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 $8,740
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,174
    Insurance broker organization code?3
    Insurance broker nameSHAFER INSURANCE AGENCY, INC
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 2
    Insurance contract or identification number127720
    Number of Individuals Covered232
    Insurance policy start date2014-03-01
    Insurance policy end date2015-02-28
    Total amount of commissions paid to insurance brokerUSD $45,563
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,077
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $45,563
    Additional information about fees paid to insurance brokerACQ/RET
    Insurance broker organization code?3
    Insurance broker nameLISA HELTON
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 1
    Insurance contract or identification numberV8092
    Number of Individuals Covered88
    Insurance policy start date2014-03-01
    Insurance policy end date2015-02-28
    Total amount of commissions paid to insurance brokerUSD $8,326
    Total amount of fees paid to insurance companyUSD $346
    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 BenefitYes
    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 $51,119
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9
    Insurance broker organization code?3
    Amount paid for insurance broker fees43
    Insurance broker nameSUSIE C THORPE
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 4
    Insurance contract or identification number50017721
    Number of Individuals Covered74
    Insurance policy start date2014-03-01
    Insurance policy end date2015-02-28
    Total amount of commissions paid to insurance brokerUSD $608
    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 providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,026
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $304
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 2
    Insurance contract or identification number50017721
    Number of Individuals Covered81
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $809
    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 providedVOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $2,661
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $404
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number127720
    Policy instance 5
    Insurance contract or identification number127720
    Number of Individuals Covered224
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $53,955
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $19,733
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $53,955
    Insurance broker organization code?3
    Insurance broker nameLISA HELTON
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 4
    Insurance contract or identification numberV8092
    Number of Individuals Covered98
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $18,456
    Total amount of fees paid to insurance companyUSD $106
    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 BenefitYes
    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 $82,151
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6
    Insurance broker organization code?3
    Amount paid for insurance broker fees13
    Insurance broker nameSUSIE THORPE
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 3
    Insurance contract or identification number50017721
    Number of Individuals Covered127
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $6,233
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare 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 $20,284
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,117
    Insurance broker organization code?3
    Insurance broker nameGROUP INSURANCE SERVICES INC
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50017721
    Policy instance 1
    Insurance contract or identification number50017721
    Number of Individuals Covered220
    Insurance policy start date2013-03-01
    Insurance policy end date2014-02-28
    Total amount of commissions paid to insurance brokerUSD $2,613
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 $12,188
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,386
    Insurance broker organization code?3
    Insurance broker nameSHAFER INSURANCE AGENCY INC
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 2
    Insurance contract or identification numberV8092
    Number of Individuals Covered139
    Insurance policy start date2012-03-01
    Insurance policy end date2013-02-28
    Total amount of commissions paid to insurance brokerUSD $24,635
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $82,534
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,752
    Insurance broker organization code?3
    Insurance broker nameRONALD E. KIRKLAND
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742051
    Policy instance 1
    Insurance contract or identification number742051
    Number of Individuals Covered487
    Insurance policy start date2012-03-01
    Insurance policy end date2013-02-28
    Total amount of commissions paid to insurance brokerUSD $8,566
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $92,816
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,330
    Insurance broker organization code?3
    Insurance broker nameBRIAN ANTHONY JONES
    UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
    Policy contract numberE876
    Policy instance 1
    Insurance contract or identification numberE876
    Number of Individuals Covered246
    Insurance policy start date2011-03-01
    Insurance policy end date2012-02-28
    Total amount of commissions paid to insurance brokerUSD $30,830
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Welfare Benefit Premiums Paid to CarrierUSD $1,027,663
    AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
    Policy contract numberG 00500767
    Policy instance 2
    Insurance contract or identification numberG 00500767
    Number of Individuals Covered18
    Insurance policy start date2011-03-01
    Insurance policy end date2012-02-29
    Total amount of commissions paid to insurance brokerUSD $1,373
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedVOLUNTARY AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $9,156
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 3
    Insurance contract or identification numberV8092
    Number of Individuals Covered116
    Insurance policy start date2011-03-01
    Insurance policy end date2012-02-29
    Total amount of commissions paid to insurance brokerUSD $13,846
    Total amount of fees paid to insurance companyUSD $433
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $57,104
    AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
    Policy contract numberV8092
    Policy instance 1
    Insurance contract or identification numberV8092
    Number of Individuals Covered87
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $10,916
    Total amount of fees paid to insurance companyUSD $850
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $46,717
    Commission paid to Insurance BrokerUSD $7,032
    Amount paid for insurance broker fees535
    Insurance broker organization code?3
    Insurance broker nameALAN MARTIN
    AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
    Policy contract numberG 00500767
    Policy instance 3
    Insurance contract or identification numberG 00500767
    Number of Individuals Covered17
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $1,580
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedVOLUNTARY AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $10,532
    Commission paid to Insurance BrokerUSD $790
    Insurance broker organization code?3
    Insurance broker nameMARKETING SERVICES
    COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
    Policy contract number536122
    Policy instance 4
    Insurance contract or identification number536122
    Number of Individuals Covered139
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $1,643
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $16,427
    Commission paid to Insurance BrokerUSD $1,643
    Insurance broker organization code?3
    Insurance broker nameBRIAN JONES
    BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number123348
    Policy instance 5
    Insurance contract or identification number123348
    Number of Individuals Covered274
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $38,673
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,289
    Commission paid to Insurance BrokerUSD $38,673
    Insurance broker organization code?3
    Insurance broker nameBRIAN JONES
    SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
    Policy contract number007-3763-00
    Policy instance 2
    Insurance contract or identification number007-3763-00
    Number of Individuals Covered301
    Insurance policy start date2010-01-01
    Insurance policy end date2011-01-01
    Total amount of commissions paid to insurance brokerUSD $1,047
    Dental Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $15,222
    Commission paid to Insurance BrokerUSD $1,047
    Insurance broker organization code?3
    Insurance broker nameBRIAN JONES

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