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SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 401k Plan overview

Plan NameSOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN
Plan identification number 503

SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY
Employer identification number (EIN):640283583
NAIC Classification:524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032019-01-01
5032018-01-01JOYCE PLUNKETT JOYCE PLUNKETT2019-01-30
5032017-01-01JOYCE PLUNKETT JOYCE PLUNKETT2018-01-24
5032017-01-01JOYCE PLUNKETT
5032016-01-01JOYCE PLUNKETT
5032016-01-01 JOYCE PLUNKETT2017-01-10
5032015-01-01BILLY SIMS
5032015-01-01BILLY SIMS
5032014-01-01BILLY SIMS BILLY SIMS2015-02-09
5032014-01-01BILLY SIMS
5032013-01-01BILLY SIMS
5032012-01-01BILLY SIMS
5032011-01-01BILLY SIMS
5032010-01-01BILLY SIMS
5032009-01-01BILLY SIMS
5032009-01-01BILLY SIMS
5032009-01-01BILLY SIMS

Plan Statistics for SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN

401k plan membership statisitcs for SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN

Measure Date Value
2019: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01187
Total number of active participants reported on line 7a of the Form 55002019-01-01181
Total of all active and inactive participants2019-01-01181
Total participants2019-01-01181
2018: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01186
Total number of active participants reported on line 7a of the Form 55002018-01-01176
Total of all active and inactive participants2018-01-01176
Total participants2018-01-01176
2017: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01185
Total number of active participants reported on line 7a of the Form 55002017-01-01185
Total of all active and inactive participants2017-01-01185
Total participants2017-01-01185
Number of retired or separated participants receiving benefits2017-01-0166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
2016: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01641
Total number of active participants reported on line 7a of the Form 55002016-01-01571
Number of retired or separated participants receiving benefits2016-01-0169
Total of all active and inactive participants2016-01-01640
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
Total participants2016-01-01641
2015: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01201
Total number of active participants reported on line 7a of the Form 55002015-01-01201
Total of all active and inactive participants2015-01-01201
Total participants2015-01-01201
Number of retired or separated participants receiving benefits2015-01-0172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-013
2014: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01209
Total number of active participants reported on line 7a of the Form 55002014-01-01209
Total of all active and inactive participants2014-01-01209
Total participants2014-01-01209
Number of retired or separated participants receiving benefits2014-01-01136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-016
2013: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01694
Total number of active participants reported on line 7a of the Form 55002013-01-01576
Number of retired or separated participants receiving benefits2013-01-01131
Total of all active and inactive participants2013-01-01707
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-017
Total participants2013-01-01714
2012: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01699
Total number of active participants reported on line 7a of the Form 55002012-01-01571
Number of retired or separated participants receiving benefits2012-01-01113
Total of all active and inactive participants2012-01-01684
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-0110
Total participants2012-01-01694
2011: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,338
Total number of active participants reported on line 7a of the Form 55002011-01-01581
Number of retired or separated participants receiving benefits2011-01-01112
Total of all active and inactive participants2011-01-01693
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-016
Total participants2011-01-01699
2010: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,344
Total number of active participants reported on line 7a of the Form 55002010-01-011,115
Number of retired or separated participants receiving benefits2010-01-01199
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,314
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-0124
Total participants2010-01-011,338
2009: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,342
Total number of active participants reported on line 7a of the Form 55002009-01-011,111
Number of retired or separated participants receiving benefits2009-01-01209
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,320
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-0124
Total participants2009-01-011,344
Number of participants with account balances2009-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011,344

Form 5500 Responses for SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN

2019: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2010 form 5500 responses
2010-01-01Type of plan entityMulitple employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: SOUTHERN FARM BUREAU LIFE INS. CO. FLEXIBLE BENEFIT CAFETERIA PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68896 )
Policy contract number2501144
Policy instance 3
Insurance contract or identification number2501144
Number of Individuals Covered645
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68896 )
Policy contract number043392571
Policy instance 2
Insurance contract or identification number043392571
Number of Individuals Covered629
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $640,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $78,692
Insurance broker nameHUB INTERNATIONAL GULF SOUTH
SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68896 )
Policy contract number76411560
Policy instance 1
Insurance contract or identification number76411560
Number of Individuals Covered629
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number043392571
Policy instance 2
Insurance contract or identification number043392571
Number of Individuals Covered641
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare 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 $413,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,807
Insurance broker nameHUB INTERNTIONAL GULF SOUTH
UNITED MEDICAL RESOURCES INC (National Association of Insurance Commissioners NAIC id number: )
Policy contract number76411560
Policy instance 1
Insurance contract or identification number76411560
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number043392571
Policy instance 2
Insurance contract or identification number043392571
Number of Individuals Covered715
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $441,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,257
Insurance broker nameHUB INTERNATIONAL GULF SOUTH
UNITED MEDICAL RESOURCES INC (National Association of Insurance Commissioners NAIC id number: )
Policy contract number76411560
Policy instance 1
Insurance contract or identification number76411560
Number of Individuals Covered715
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number043392571
Policy instance 2
Insurance contract or identification number043392571
Number of Individuals Covered714
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare 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 $451,872
Commission paid to Insurance BrokerUSD $55,493
Insurance broker nameHUB INTERNATIONAL GULF SOUTH
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number019931-33
Policy instance 1
Insurance contract or identification number019931-33
Number of Individuals Covered714
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number04-3392571
Policy instance 2
Insurance contract or identification number04-3392571
Number of Individuals Covered694
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $372,384
Commission paid to Insurance BrokerUSD $45,731
Insurance broker nameHUB INTERNATIONAL GULF SOUTH
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number019931-33
Policy instance 1
Insurance contract or identification number019931-33
Number of Individuals Covered694
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number04-3392571
Policy instance 2
Insurance contract or identification number04-3392571
Number of Individuals Covered699
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $338,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number019931-33
Policy instance 1
Insurance contract or identification number019931-33
Number of Individuals Covered699
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number04-3392571
Policy instance 2
Insurance contract or identification number04-3392571
Number of Individuals Covered1338
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $560,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,265
Insurance broker nameSTRATEGIC EMPLOYEE BENEFIT SERVICE
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number019931-33
Policy instance 1
Insurance contract or identification number019931-33
Number of Individuals Covered1338
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameNOT APPLICABLE

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