INDEPENDENT FURNITURE SUPPLY CO., INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN
401k plan membership statisitcs for INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 346 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 288 |
| Total of all active and inactive participants | 2022-01-01 | 288 |
| Total participants | 2022-01-01 | 288 |
| 2021: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 346 |
| Total of all active and inactive participants | 2021-01-01 | 346 |
| Total participants | 2021-01-01 | 346 |
| 2020: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 311 |
| Total of all active and inactive participants | 2020-01-01 | 311 |
| Total participants | 2020-01-01 | 311 |
| 2019: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 347 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 205 |
| Total of all active and inactive participants | 2019-01-01 | 205 |
| Total participants | 2019-01-01 | 205 |
| 2018: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 388 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 347 |
| Total of all active and inactive participants | 2018-01-01 | 347 |
| Total participants | 2018-01-01 | 347 |
| 2017: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 384 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 388 |
| Total of all active and inactive participants | 2017-01-01 | 388 |
| Total participants | 2017-01-01 | 388 |
| 2016: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 427 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 384 |
| Total of all active and inactive participants | 2016-01-01 | 384 |
| Total participants | 2016-01-01 | 384 |
| 2015: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 439 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 427 |
| Total of all active and inactive participants | 2015-01-01 | 427 |
| Total participants | 2015-01-01 | 0 |
| 2014: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 439 |
| Total of all active and inactive participants | 2014-01-01 | 439 |
| Total participants | 2014-01-01 | 0 |
| 2013: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 396 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 422 |
| Total of all active and inactive participants | 2013-01-01 | 422 |
| 2012: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 239 |
| Total of all active and inactive participants | 2012-01-01 | 239 |
| 2011: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 202 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 225 |
| Total of all active and inactive participants | 2011-01-01 | 225 |
| 2010: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 202 |
| Total of all active and inactive participants | 2010-01-01 | 202 |
| 2009: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-02 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-02 | 154 |
| Total of all active and inactive participants | 2009-01-02 | 154 |
| 2008: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 270 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 233 |
| Total of all active and inactive participants | 2008-01-01 | 233 |
| 2007: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 232 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 270 |
| Total of all active and inactive participants | 2007-01-01 | 270 |
| 2006: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-01-01 | 213 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-01-01 | 232 |
| Total of all active and inactive participants | 2006-01-01 | 232 |
| 2005: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-01-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-01-01 | 213 |
| Total of all active and inactive participants | 2005-01-01 | 213 |
| 2003: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-08-01 | 222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-08-01 | 200 |
| Total of all active and inactive participants | 2003-08-01 | 200 |
| 2022: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | This submission is the final filing | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-02 | Type of plan entity | Single employer plan |
| 2009-01-02 | Submission has been amended | No |
| 2009-01-02 | This submission is the final filing | No |
| 2009-01-02 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-02 | Plan is a collectively bargained plan | No |
| 2009-01-02 | Plan funding arrangement – Insurance | Yes |
| 2009-01-02 | Plan benefit arrangement – Insurance | Yes |
| 2008: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | Submission has been amended | No |
| 2007-01-01 | This submission is the final filing | No |
| 2007-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-01-01 | Plan is a collectively bargained plan | No |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2006 form 5500 responses |
|---|
| 2006-01-01 | Type of plan entity | Single employer plan |
| 2006-01-01 | Submission has been amended | No |
| 2006-01-01 | This submission is the final filing | No |
| 2006-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-01-01 | Plan is a collectively bargained plan | No |
| 2006-01-01 | Plan funding arrangement – Insurance | Yes |
| 2006-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2005 form 5500 responses |
|---|
| 2005-01-01 | Type of plan entity | Single employer plan |
| 2005-01-01 | Submission has been amended | No |
| 2005-01-01 | This submission is the final filing | No |
| 2005-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-01-01 | Plan is a collectively bargained plan | No |
| 2005-01-01 | Plan funding arrangement – Insurance | Yes |
| 2005-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: INDEPENDENT FURNITURE SUPPLY CO. INC. WELFARE PLAN 2003 form 5500 responses |
|---|
| 2003-08-01 | Type of plan entity | Single employer plan |
| 2003-08-01 | Submission has been amended | No |
| 2003-08-01 | This submission is the final filing | No |
| 2003-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-08-01 | Plan is a collectively bargained plan | No |
| 2003-08-01 | Plan funding arrangement – Insurance | Yes |
| 2003-08-01 | Plan benefit arrangement – Insurance | Yes |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417003415005 |
| Policy instance | 2 |
| Insurance contract or identification number | 417003415005 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 288 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $42,814 | | Total amount of fees paid to insurance company | USD $415 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $175,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 109 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417003415005 |
| Policy instance | 6 |
| Insurance contract or identification number | 417003415005 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-07-01 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $40,015 | | Total amount of fees paid to insurance company | USD $737 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $208,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,273 | | Amount paid for insurance broker fees | 173 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 2 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 226 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $2,862 | | Total amount of fees paid to insurance company | USD $986 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,674 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 986 |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 048008 |
| Policy instance | 3 |
| Insurance contract or identification number | 048008 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-06-01 | | Total amount of commissions paid to insurance broker | USD $25,525 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,525 | | Insurance broker organization code? | 3 |
|
| AMFIRST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60250 ) |
| Policy contract number | 22507 |
| Policy instance | 4 |
| Insurance contract or identification number | 22507 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $11,542 | | Other welfare benefits provided | PREMIUM SAVER | | Welfare Benefit Premiums Paid to Carrier | USD $115,450 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,820 | | Insurance broker organization code? | 3 |
|
| STHEALTH/CHARTIS (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 417002415005 |
| Policy instance | 5 |
| Insurance contract or identification number | 417002415005 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 2 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 237 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $2,863 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,383 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 048008 |
| Policy instance | 3 |
| Insurance contract or identification number | 048008 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-01 | | Total amount of commissions paid to insurance broker | USD $59,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,675 |
|
| AMFIRST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60250 ) |
| Policy contract number | 22507 |
| Policy instance | 4 |
| Insurance contract or identification number | 22507 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-01 | | Total amount of commissions paid to insurance broker | USD $14,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,264 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $41,718 | | Total amount of fees paid to insurance company | USD $1,519 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $250,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,822 | | Amount paid for insurance broker fees | 176 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GLIUME001683 |
| Policy instance | 3 |
| Insurance contract or identification number | GLIUME001683 | | Number of Individuals Covered | 220 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Welfare Benefit Premiums Paid to Carrier | USD $252,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 2 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 96 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-04-01 | | Total amount of commissions paid to insurance broker | USD $8,367 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,837 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,367 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $40,677 | | Total amount of fees paid to insurance company | USD $1,373 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $218,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,192 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 184 |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 048008 |
| Policy instance | 5 |
| Insurance contract or identification number | 048008 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $35,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,950 |
|
| AMERICAN FIDELITY ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 205 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $14,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82538 ) |
| Policy contract number | 02402 &02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 &02403 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $96,565 | | Total amount of fees paid to insurance company | USD $161,803 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $677,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 130351 | | Additional information about fees paid to insurance broker | TPA FEES / WELLNESS PROGRAM | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $58,006 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 3 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $8,392 | | Total amount of fees paid to insurance company | USD $952 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,392 | | Amount paid for insurance broker fees | 952 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $41,059 | | Total amount of fees paid to insurance company | USD $1,678 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $219,357 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,414 | | Amount paid for insurance broker fees | 174 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 133 | | Insurance policy start date | 2016-04-01 | | Insurance policy end date | 2017-04-01 | | Total amount of commissions paid to insurance broker | USD $8,592 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,959 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,892 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 3 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $1,727 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD, LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $16,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,727 | | Insurance broker organization code? | 3 | | Insurance broker name | GCM INSURANCE AGENCY |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 02402 &02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 &02403 | | Number of Individuals Covered | 388 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $20,448 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,448 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MCKINNEY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $41,352 | | Total amount of fees paid to insurance company | USD $1,357 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $209,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,043 | | Amount paid for insurance broker fees | 415 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MELISSA J JENKINS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 151 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-04-01 | | Total amount of commissions paid to insurance broker | USD $8,823 | | Total amount of fees paid to insurance company | USD $2,355 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,823 | | Amount paid for insurance broker fees | 2355 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 3 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $1,871 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $18,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,871 | | Insurance broker organization code? | 3 | | Insurance broker name | GCM INSURANCE AGENCY |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 02402 &02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 &02403 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $51,564 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,564 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MCKINNEY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $42,652 | | Total amount of fees paid to insurance company | USD $1,544 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $175,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,359 | | Amount paid for insurance broker fees | 440 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | HARDY INSURANCE INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 124 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $8,256 | | Total amount of fees paid to insurance company | USD $2,302 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,256 | | Amount paid for insurance broker fees | 2302 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 3 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $1,685 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $16,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,685 | | Insurance broker organization code? | 3 | | Insurance broker name | GCM INSURANCE AGENCY |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 02402 &02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 &02403 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $47,919 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,919 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MCKINNEY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $44,696 | | Total amount of fees paid to insurance company | USD $1,461 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $195,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,672 | | Amount paid for insurance broker fees | 367 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ALLISON M MASSEY |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 02402 & 02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 & 02403 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $48,378 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,378 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MCKINNEY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $41,433 | | Total amount of fees paid to insurance company | USD $781 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $178,048 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $12,755 | | Amount paid for insurance broker fees | 249 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | 49 MORE AFLAC AGENTS |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 3 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,844 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $18,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,844 | | Insurance broker organization code? | 3 | | Insurance broker name | GMC INSURANCE AGENCY LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 161 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $8,309 | | Total amount of fees paid to insurance company | USD $1,599 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,309 | | Amount paid for insurance broker fees | 1599 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | 470322111 |
| Policy instance | 4 |
| Insurance contract or identification number | 470322111 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $8,501 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,067 | | Commission paid to Insurance Broker | USD $8,501 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 3 |
| Insurance contract or identification number | 10201 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $58,618 | | Total amount of fees paid to insurance company | USD $1,850 | | Other welfare benefits provided | AFLAC PRODUCTS | | Commission paid to Insurance Broker | USD $12,042 | | Amount paid for insurance broker fees | 437 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | 45 OTHER AFLAC AGENTS |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 02402 AND 02403 |
| Policy instance | 2 |
| Insurance contract or identification number | 02402 AND 02403 | | Number of Individuals Covered | 396 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $46,405 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,405 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MCKINNEY |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 1 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,840 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $19,553 | | Commission paid to Insurance Broker | USD $2,840 | | Insurance broker organization code? | 3 | | Insurance broker name | GCM INSURANCE AGENCY LLC |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 2402 AND 2403 |
| Policy instance | 3 |
| Insurance contract or identification number | 2402 AND 2403 | | Number of Individuals Covered | 403 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $45,718 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 2 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 220 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,119 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,593 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $112,809 | | Total amount of fees paid to insurance company | USD $1,370 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $139,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 150 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $7,314 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,657 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 1 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,485 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,428 | | 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 number | 0046598 |
| Policy instance | 2 |
| Insurance contract or identification number | 0046598 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Other welfare benefits provided | REINSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $160,199 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 3 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $22,397 | | Total amount of fees paid to insurance company | USD $742 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $105,680 |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 2402 AND 2403 |
| Policy instance | 4 |
| Insurance contract or identification number | 2402 AND 2403 | | Number of Individuals Covered | 378 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $20,785 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 5 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 123 | | Insurance policy start date | 2009-04-01 | | Insurance policy end date | 2010-03-31 | | Total amount of commissions paid to insurance broker | USD $6,020 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,791 | | 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 number | 0046598 |
| Policy instance | 1 |
| Insurance contract or identification number | 0046598 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | Welfare Benefit Premiums Paid to Carrier | USD $160,028 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 2 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2008-07-01 | | Insurance policy end date | 2009-06-30 | | Total amount of commissions paid to insurance broker | USD $24,027 | | Total amount of fees paid to insurance company | USD $1,243 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $114,923 | | Commission paid to Insurance Broker | USD $10,191 | | Amount paid for insurance broker fees | 778 | | Additional information about fees paid to insurance broker | ADDITIONAL PRODUCER COMP | | Insurance broker organization code? | 3 | | Insurance broker name | 22 ADDITIONAL AFLAC AGENTS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 3 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 99 | | Insurance policy start date | 2008-04-01 | | Insurance policy end date | 2009-03-31 | | Total amount of commissions paid to insurance broker | USD $5,684 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,075 | | Commission paid to Insurance Broker | USD $5,684 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 4 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $5,106 | | Total amount of fees paid to insurance company | USD $191 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $25,529 | | Commission paid to Insurance Broker | USD $5,106 | | Amount paid for insurance broker fees | 191 | | Additional information about fees paid to insurance broker | ADDITIONAL PRODUCER COMP | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 4 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 144 | | Insurance policy start date | 2007-04-01 | | Insurance policy end date | 2008-03-31 | | Total amount of commissions paid to insurance broker | USD $6,977 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,929 | | Commission paid to Insurance Broker | USD $6,977 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 3 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2007-07-01 | | Insurance policy end date | 2008-06-30 | | Total amount of commissions paid to insurance broker | USD $40,052 | | Total amount of fees paid to insurance company | USD $1,376 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $162,223 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,943 | | Amount paid for insurance broker fees | 472 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | 24 ADDITIONAL AFLAC AGENTS |
|
| BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 ) |
| Policy contract number | 0046598 |
| Policy instance | 2 |
| Insurance contract or identification number | 0046598 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Other welfare benefits provided | REINSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $168,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 1 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $8,995 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $44,975 | | Commission paid to Insurance Broker | USD $8,995 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2006-07-01 | | Insurance policy end date | 2007-06-30 | | Total amount of commissions paid to insurance broker | USD $44,857 | | Total amount of fees paid to insurance company | USD $3,142 | | Welfare Benefit Premiums Paid to Carrier | USD $171,718 | | Commission paid to Insurance Broker | USD $18,726 | | Amount paid for insurance broker fees | 1331 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | 20 ADDITIONAL AFLAC AGENTS |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 2 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $9,442 | | Total amount of fees paid to insurance company | USD $354 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $47,211 | | Commission paid to Insurance Broker | USD $9,442 | | Amount paid for insurance broker fees | 354 | | Additional information about fees paid to insurance broker | ADDITIONAL PRODUCER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000602E |
| Policy instance | 3 |
| Insurance contract or identification number | G000602E | | Number of Individuals Covered | 158 | | Insurance policy start date | 2006-04-01 | | Insurance policy end date | 2007-03-31 | | Total amount of commissions paid to insurance broker | USD $8,117 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,429 | | Commission paid to Insurance Broker | USD $8,117 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INC. |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 1 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2005-07-01 | | Insurance policy end date | 2006-06-30 | | Total amount of commissions paid to insurance broker | USD $21,922 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $121,617 | | Commission paid to Insurance Broker | USD $10,661 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | 15 ADDITIONAL AFLAC AGENTS |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 2 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2006-01-01 | | Insurance policy end date | 2006-12-31 | | Total amount of commissions paid to insurance broker | USD $9,793 | | Total amount of fees paid to insurance company | USD $623 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $48,965 | | Commission paid to Insurance Broker | USD $9,793 | | Amount paid for insurance broker fees | 623 | | Additional information about fees paid to insurance broker | ADDITIONAL PRODUCER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INC |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 10201 |
| Policy instance | 2 |
| Insurance contract or identification number | 10201 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2004-07-01 | | Insurance policy end date | 2005-06-30 | | Total amount of commissions paid to insurance broker | USD $25,267 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AFLAC PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $119,719 | | Commission paid to Insurance Broker | USD $7,328 | | Insurance broker organization code? | 3 | | Insurance broker name | 20 ADDITIONAL AFLAC AGENTS |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 1 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2005-01-01 | | Insurance policy end date | 2005-12-31 | | Total amount of commissions paid to insurance broker | USD $10,186 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $46,967 | | Commission paid to Insurance Broker | USD $10,186 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 533626 |
| Policy instance | 1 |
| Insurance contract or identification number | 533626 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2003-08-01 | | Insurance policy end date | 2003-12-31 | | Total amount of commissions paid to insurance broker | USD $8,717 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,717 | | Insurance broker organization code? | 2 | | Insurance broker name | ROSS & YERGER, INC. |
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