INTERNATIONAL COMPUTER SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Additional information about INTERNATIONAL COMPUTER SYSTEMS, INC.
Submission information for form 5500 for 401k plan THE ICS, INC. PREMIUM ONLY PLAN
401k plan membership statisitcs for THE ICS, INC. PREMIUM ONLY PLAN
| Measure | Date | Value |
|---|
| 2022 : THE ICS, INC. PREMIUM ONLY PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $755,570 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $755,570 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $755,570 |
| Total contributions received or receivable from participants | 2022-12-31 | $239,877 |
| Net income (gross income less expenses) | 2022-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $515,693 |
| 2021 : THE ICS, INC. PREMIUM ONLY PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $739,252 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $739,252 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $739,252 |
| Total contributions received or receivable from participants | 2021-12-31 | $211,589 |
| Net income (gross income less expenses) | 2021-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $527,663 |
| 2020 : THE ICS, INC. PREMIUM ONLY PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $664,543 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $664,543 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $664,543 |
| Total contributions received or receivable from participants | 2020-12-31 | $342,447 |
| Net income (gross income less expenses) | 2020-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $322,096 |
| 2019 : THE ICS, INC. PREMIUM ONLY PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $733,477 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $733,477 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $733,477 |
| Total contributions received or receivable from participants | 2019-12-31 | $210,697 |
| Net income (gross income less expenses) | 2019-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $522,780 |
| 2018 : THE ICS, INC. PREMIUM ONLY PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $682,814 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $682,814 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $682,814 |
| Total contributions received or receivable from participants | 2018-12-31 | $194,101 |
| Net income (gross income less expenses) | 2018-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $488,713 |
| 2017 : THE ICS, INC. PREMIUM ONLY PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $588,953 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $588,953 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $588,953 |
| Total contributions received or receivable from participants | 2017-12-31 | $172,809 |
| Net income (gross income less expenses) | 2017-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $416,144 |
| 2016 : THE ICS, INC. PREMIUM ONLY PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $551,784 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $551,784 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $551,784 |
| Total contributions received or receivable from participants | 2016-12-31 | $181,659 |
| Net income (gross income less expenses) | 2016-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $370,125 |
| 2014 : THE ICS, INC. PREMIUM ONLY PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $601,944 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $601,944 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $601,944 |
| Total contributions received or receivable from participants | 2014-12-31 | $154,460 |
| Net income (gross income less expenses) | 2014-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $447,484 |
| 2013 : THE ICS, INC. PREMIUM ONLY PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $581,887 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $581,887 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $581,887 |
| Total contributions received or receivable from participants | 2013-12-31 | $119,991 |
| Net income (gross income less expenses) | 2013-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $461,896 |
| 2012 : THE ICS, INC. PREMIUM ONLY PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $620,701 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $620,701 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $620,701 |
| Total contributions received or receivable from participants | 2012-12-31 | $143,141 |
| Net income (gross income less expenses) | 2012-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $477,560 |
| 2011 : THE ICS, INC. PREMIUM ONLY PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $574,972 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $574,972 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $574,972 |
| Total contributions received or receivable from participants | 2011-12-31 | $168,560 |
| Net income (gross income less expenses) | 2011-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $406,412 |
| 2010 : THE ICS, INC. PREMIUM ONLY PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $532,455 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $532,455 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $532,455 |
| Total contributions received or receivable from participants | 2010-12-31 | $135,217 |
| Net income (gross income less expenses) | 2010-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $397,238 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,296 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,296 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $160 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $84 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,964 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,809 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $597 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $3,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $544 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $146 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $122 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $537 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $3,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $467 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $413 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $333 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $188 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,282 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,282 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $538 | | Total amount of fees paid to insurance company | USD $19 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $4,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $432 | | Amount paid for insurance broker fees | 11 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $141 | | Total amount of fees paid to insurance company | USD $3 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99 | | Amount paid for insurance broker fees | 2 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $667 | | Total amount of fees paid to insurance company | USD $27 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $4,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $555 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,440 | | Total amount of fees paid to insurance company | USD $25 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,000 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $372 | | Total amount of fees paid to insurance company | USD $5 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Amount paid for insurance broker fees | 3 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $199 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $105 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $1,115 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,115 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $724 | | Total amount of fees paid to insurance company | USD $56 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $5,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $605 | | Amount paid for insurance broker fees | 53 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $197 | | Total amount of fees paid to insurance company | USD $7 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $150 | | Amount paid for insurance broker fees | 5 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $600 | | Total amount of fees paid to insurance company | USD $34 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $4,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $478 | | Amount paid for insurance broker fees | 23 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $309 | | Total amount of fees paid to insurance company | USD $13 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $249 | | Amount paid for insurance broker fees | 8 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $6,575 | | Total amount of fees paid to insurance company | USD $204 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,302 | | Amount paid for insurance broker fees | 133 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $271 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $221 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $383 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $3,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $288 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $117 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $926 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $4,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $835 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $1,369 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,369 | | Insurance broker organization code? | 3 |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $158 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,009 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,357 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,089 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $322 | | Total amount of fees paid to insurance company | USD $21 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $260 | | Amount paid for insurance broker fees | 21 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $656 | | Total amount of fees paid to insurance company | USD $117 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $4,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $508 | | Amount paid for insurance broker fees | 117 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $155 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $104 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $566 | | Total amount of fees paid to insurance company | USD $84 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $4,237 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $442 | | Amount paid for insurance broker fees | 84 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $1,395 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,395 | | Insurance broker organization code? | 3 |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $187 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,249 | | Total amount of fees paid to insurance company | USD $176 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,052 | | Amount paid for insurance broker fees | 176 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 1 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $187 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $100 | | Insurance broker organization code? | 3 | | Insurance broker name | GEORGE BURKS |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 2 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | GEORGE BURKS |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 3 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061483 |
| Policy instance | 4 |
| Insurance contract or identification number | 061483 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $1,278 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,278 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 5 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,583 | | Total amount of fees paid to insurance company | USD $109 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $5,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,381 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 85 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker name | GEORGE BURKS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 6 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $554 | | Total amount of fees paid to insurance company | USD $42 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $2,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $460 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker name | GEORGE BURKS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 7 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,527 | | Total amount of fees paid to insurance company | USD $112 | | Other welfare benefits provided | ECR HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $6,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,313 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 88 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker name | GEORGE BURKS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 9 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,649 | | Total amount of fees paid to insurance company | USD $223 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,584 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 174 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker name | GEORGE BURKS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 8 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $255 | | Total amount of fees paid to insurance company | USD $10 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $207 | | Amount paid for insurance broker fees | 2 | | Additional information about fees paid to insurance broker | GENERAL | | Insurance broker organization code? | 3 | | Insurance broker name | GEORGE BURKS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 2 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $140 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $80 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES PEW |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 4 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 3 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 67194 |
| Policy instance | 1 |
| Insurance contract or identification number | 67194 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $11,015 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,020 | | Insurance broker name | AF SMITH & ASSOCIATES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 3 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 67194 |
| Policy instance | 1 |
| Insurance contract or identification number | 67194 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,760 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,075 | | Insurance broker organization code? | 3 | | Insurance broker name | AF SMITH & ASSOCIATES |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 4 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 2 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $169 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES PEW |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 67194 |
| Policy instance | 2 |
| Insurance contract or identification number | 67194 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,543 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,700 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50010513 |
| Policy instance | 3 |
| Insurance contract or identification number | 50010513 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $399 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $228 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES PEW |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027273 |
| Policy instance | 4 |
| Insurance contract or identification number | 027273 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $3,388 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental 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 $3,388 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 ) |
| Policy contract number | 774859 |
| Policy instance | 5 |
| Insurance contract or identification number | 774859 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $12,834 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 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 $12,834 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 1153 |
| Policy instance | 1 |
| Insurance contract or identification number | 1153 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,012 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental 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 $1,012 | | Insurance broker organization code? | 3 | | Insurance broker name | HARVEY E. MOORE |
|
| QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 ) |
| Policy contract number | 76123 |
| Policy instance | 1 |
| Insurance contract or identification number | 76123 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,157 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | E793 |
| Policy instance | 5 |
| Insurance contract or identification number | E793 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $14,206 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $443,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 67194 |
| Policy instance | 3 |
| Insurance contract or identification number | 67194 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,543 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 1153 |
| Policy instance | 2 |
| Insurance contract or identification number | 1153 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,161 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 ) |
| Policy contract number | 76123 |
| Policy instance | 1 |
| Insurance contract or identification number | 76123 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $13,368 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 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 $13,368 | | Insurance broker organization code? | 3 | | Insurance broker name | HAWKINS INSURANCE AGENCY |
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| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 1153 |
| Policy instance | 2 |
| Insurance contract or identification number | 1153 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,018 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental 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 $6,018 | | Insurance broker organization code? | 3 | | Insurance broker name | HARVEY E. MOORE |
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| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 67194 |
| Policy instance | 3 |
| Insurance contract or identification number | 67194 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,060 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,347 | | Insurance broker organization code? | 3 | | Insurance broker name | HARVEY E. MOORE |
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