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EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 401k Plan overview

Plan NameEMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY
Plan identification number 506

EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

OUACHITA COUNTY MEDICAL CENTER VISION CARE PLAN has sponsored the creation of one or more 401k plans.

Company Name:OUACHITA COUNTY MEDICAL CENTER VISION CARE PLAN
Employer identification number (EIN):710766341
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062022-02-01PEGGY ABBOTT2023-11-07
5062021-02-01PEGGY ABBOTT2022-07-11
5062020-02-01PEGGY ABBOTT2021-10-05
5062019-02-01PEGGY ABBOTT2021-10-05
5062018-02-01PEGGY ABBOTT2021-10-05
5062017-02-01PEGGY ABBOTT
5062016-02-01PEGGY ABBOTT
5062015-02-01PEGGY ABBOTT
5062014-02-01PEGGY ABBOTT
5062013-02-01ROBERT ANDERS
5062012-02-01ROBERT ANDERS
5062011-02-01ROBERT ANDERS
5062009-02-01ROBERT ANDERS

Plan Statistics for EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY

401k plan membership statisitcs for EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY

Measure Date Value
2022: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2022 401k membership
Total participants, beginning-of-year2022-02-01163
Total number of active participants reported on line 7a of the Form 55002022-02-01194
Total of all active and inactive participants2022-02-01194
2021: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year2021-02-01170
Total number of active participants reported on line 7a of the Form 55002021-02-01163
Total of all active and inactive participants2021-02-01163
2020: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year2020-02-01154
Total number of active participants reported on line 7a of the Form 55002020-02-01170
Total of all active and inactive participants2020-02-01170
2019: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year2019-02-01181
Total number of active participants reported on line 7a of the Form 55002019-02-01154
Total of all active and inactive participants2019-02-01154
2018: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year2018-02-01194
Total number of active participants reported on line 7a of the Form 55002018-02-01181
Total of all active and inactive participants2018-02-01181
2017: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year2017-02-01284
Total number of active participants reported on line 7a of the Form 55002017-02-01194
Total of all active and inactive participants2017-02-01194
Total participants2017-02-01194
2016: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year2016-02-01276
Total number of active participants reported on line 7a of the Form 55002016-02-01284
Total of all active and inactive participants2016-02-01284
Total participants2016-02-01284
2015: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year2015-02-01692
Total number of active participants reported on line 7a of the Form 55002015-02-01276
Total of all active and inactive participants2015-02-01276
Total participants2015-02-01276
2014: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year2014-02-01277
Total number of active participants reported on line 7a of the Form 55002014-02-01692
Total of all active and inactive participants2014-02-01692
Total participants2014-02-01692
2013: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year2013-02-01274
Total number of active participants reported on line 7a of the Form 55002013-02-01277
Total of all active and inactive participants2013-02-01277
Total participants2013-02-01277
2012: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-02-01257
Total number of active participants reported on line 7a of the Form 55002012-02-01274
Total of all active and inactive participants2012-02-01274
Total participants2012-02-01274
2011: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-02-01262
Total number of active participants reported on line 7a of the Form 55002011-02-01257
Total of all active and inactive participants2011-02-01257
Total participants2011-02-01257
2009: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-02-01266
Total number of active participants reported on line 7a of the Form 55002009-02-01255
Total of all active and inactive participants2009-02-01255
Total participants2009-02-01255

Form 5500 Responses for EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY

2022: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedYes
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 2
Insurance contract or identification number0356000000
Number of Individuals Covered194
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $32,923
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $136,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,923
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered21
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $1,135
Total amount of fees paid to insurance companyUSD $289
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $5,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,135
Amount paid for insurance broker fees289
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Number of Individuals Covered199
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $8,508
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $47,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,508
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Number of Individuals Covered156
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $12,723
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $54,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,723
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 2
Insurance contract or identification number0356000000
Number of Individuals Covered163
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $37,143
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $142,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,143
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered63
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $3,332
Total amount of fees paid to insurance companyUSD $821
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $16,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,332
Amount paid for insurance broker fees821
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered61
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $3,676
Total amount of fees paid to insurance companyUSD $609
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $18,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,676
Amount paid for insurance broker fees609
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 2
Insurance contract or identification number0356000000
Number of Individuals Covered172
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $36,915
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $161,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,475
Insurance broker organization code?3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Number of Individuals Covered170
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $10,677
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $54,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,346
Insurance broker organization code?3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $7,949
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $38,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 2
Insurance contract or identification number0356000000
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $28,092
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $122,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered78
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $4,973
Total amount of fees paid to insurance companyUSD $427
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $24,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 2
Insurance contract or identification number0356000000
Number of Individuals Covered181
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $46,562
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $158,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,122
Insurance broker organization code?3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Number of Individuals Covered140
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $11,608
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $49,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,277
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered100
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $3,114
Total amount of fees paid to insurance companyUSD $1,339
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $19,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,114
Amount paid for insurance broker fees1339
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberA2956
Policy instance 1
Insurance contract or identification numberA2956
Number of Individuals Covered8
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $268
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedCANCR,DISAB,HRT/STROKE,TM&UNIV LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 2
Insurance contract or identification number000405004057
Number of Individuals Covered80
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $2,750
Total amount of fees paid to insurance companyUSD $170
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $13,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,750
Amount paid for insurance broker fees170
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameJTS FINANCIAL SERVICES
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 3
Insurance contract or identification number0356000000
Number of Individuals Covered194
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $45,084
Other welfare benefits providedUNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $110,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,084
Insurance broker organization code?3
Insurance broker nameJTS FINANCIAL SERVICES
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number0356000000
Policy instance 4
Insurance contract or identification number0356000000
Number of Individuals Covered125
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $8,109
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $34,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,109
Insurance broker organization code?3
Insurance broker nameJTS FINANCIAL SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000405004057
Policy instance 1
Insurance contract or identification number000405004057
Number of Individuals Covered88
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $3,991
Total amount of fees paid to insurance companyUSD $2,534
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $19,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,991
Insurance broker organization code?3
Amount paid for insurance broker fees2534
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameACUITY GROUP OF MS LLC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberA2956
Policy instance 2
Insurance contract or identification numberA2956
Number of Individuals Covered43
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $999
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29
Insurance broker organization code?3
Insurance broker nameLEIGH ANN JOHNSON-MACON
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number035600000
Policy instance 3
Insurance contract or identification number035600000
Number of Individuals Covered94
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $17,226
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $28,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,226
Insurance broker organization code?3
Insurance broker nameJTS FINANCIAL SERVICES
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number035600000
Policy instance 4
Insurance contract or identification number035600000
Number of Individuals Covered118
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $68,587
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,587
Insurance broker organization code?3
Insurance broker nameJTS FINANCIAL SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010196185
Policy instance 5
Insurance contract or identification number000010196185
Number of Individuals Covered101
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $10,026
Total amount of fees paid to insurance companyUSD $3,762
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $66,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,026
Insurance broker organization code?3
Amount paid for insurance broker fees3762
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameACUITY GROUP OF MS, LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010196184
Policy instance 7
Insurance contract or identification number000010196184
Number of Individuals Covered255
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $5,544
Total amount of fees paid to insurance companyUSD $2,179
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,544
Insurance broker organization code?3
Amount paid for insurance broker fees2179
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameACUITY GROUP OF MS, LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010198222
Policy instance 6
Insurance contract or identification number000010198222
Number of Individuals Covered276
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $1,469
Total amount of fees paid to insurance companyUSD $555
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,469
Insurance broker organization code?3
Amount paid for insurance broker fees555
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameACUITY GROUP OF MS, LLC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 6
Insurance contract or identification number50003921
Number of Individuals Covered256
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $457
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $422
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 9
Insurance contract or identification number50003921
Number of Individuals Covered215
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $16,939
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $70,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,792
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 8
Insurance contract or identification number0004363IN
Number of Individuals Covered3
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $2,820
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $521
Insurance broker organization code?3
Insurance broker nameJEREMY BELL
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 7
Insurance contract or identification number0004363IN
Number of Individuals Covered140
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $4,099
Other welfare benefits providedCRITICAL CARE
Welfare Benefit Premiums Paid to CarrierUSD $33,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $495
Insurance broker organization code?3
Insurance broker nameJEFFREY PENNINGTON
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 5
Insurance contract or identification number50003921
Number of Individuals Covered136
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $27,475
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $114,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,182
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 4
Insurance contract or identification number0004363IN
Number of Individuals Covered134
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $5,139
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $31,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,098
Insurance broker organization code?3
Insurance broker nameJEREMY BELL
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 3
Insurance contract or identification number50003921
Number of Individuals Covered692
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $819
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $732
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 2
Insurance contract or identification number221738
Number of Individuals Covered4
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,624
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 number0004363IN
Policy instance 1
Insurance contract or identification number0004363IN
Number of Individuals Covered6
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $19
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8
Insurance broker organization code?3
Insurance broker nameJONATHAN ANDERSON
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 3
Insurance contract or identification number221738
Number of Individuals Covered13
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,136
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 number50003921
Policy instance 5
Insurance contract or identification number50003921
Number of Individuals Covered123
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $8,479
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $42,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,120
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 9
Insurance contract or identification number50003921
Number of Individuals Covered277
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $112
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $112
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 4
Insurance contract or identification number0004363IN
Number of Individuals Covered124
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $2,133
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $16,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $336
Insurance broker organization code?3
Insurance broker nameSCOTT SAMPLE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 6
Insurance contract or identification number50003921
Number of Individuals Covered254
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $330
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $330
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 7
Insurance contract or identification number0004363IN
Number of Individuals Covered3
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $1,591
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,157
Insurance broker organization code?3
Insurance broker nameJEREMY BELL
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 1
Insurance contract or identification number0004363IN
Number of Individuals Covered8
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $15
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7
Insurance broker organization code?3
Insurance broker nameJONATHAN ANDERSON
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 8
Insurance contract or identification number50003921
Number of Individuals Covered199
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $5,708
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $28,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,427
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 2
Insurance contract or identification number0004363IN
Number of Individuals Covered193
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,075
Other welfare benefits providedCRITICAL CARE
Welfare Benefit Premiums Paid to CarrierUSD $26,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $433
Insurance broker organization code?3
Insurance broker nameSCOTT SAMPLE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 1
Insurance contract or identification number0004363IN
Number of Individuals Covered9
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $19
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
Insurance broker nameJONATHAN ANDERSON
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 9
Insurance contract or identification number50003921
Number of Individuals Covered117
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $12,767
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $63,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $3,192
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 8
Insurance contract or identification number0004363IN
Number of Individuals Covered192
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $12,641
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $39,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,551
Insurance broker organization code?3
Insurance broker nameSCOTT SAMPLE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 6
Insurance contract or identification number0004363IN
Number of Individuals Covered110
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $3,965
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $22,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Insurance broker organization code?3
Insurance broker nameSCOTT SAMPLE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 5
Insurance contract or identification number50003921
Number of Individuals Covered190
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $11,003
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $55,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,751
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003921
Policy instance 4
Insurance contract or identification number50003921
Number of Individuals Covered274
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $215
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $215
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 3
Insurance contract or identification number221738
Number of Individuals Covered13
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,522
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 number50003921
Policy instance 2
Insurance contract or identification number50003921
Number of Individuals Covered199
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $263
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $263
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363IND
Policy instance 7
Insurance contract or identification number4363IND
Number of Individuals Covered2
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,810
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $295
Insurance broker organization code?3
Insurance broker nameROBERT WESTERMAN
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number0004363IN
Policy instance 2
Insurance contract or identification number0004363IN
Number of Individuals Covered192
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $12,641
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $39,000
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 number50003921
Policy instance 7
Insurance contract or identification number50003921
Number of Individuals Covered199
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $263
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 8
Insurance contract or identification number221738
Number of Individuals Covered9
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $2
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,845
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 number4363IND
Policy instance 6
Insurance contract or identification number4363IND
Number of Individuals Covered2
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,810
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,916
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 number0004363IN
Policy instance 4
Insurance contract or identification number0004363IN
Number of Individuals Covered9
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $19
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,622
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 number0004363IN
Policy instance 3
Insurance contract or identification number0004363IN
Number of Individuals Covered110
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $3,965
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $22,061
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 number50003921
Policy instance 1
Insurance contract or identification number50003921
Number of Individuals Covered117
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $12,767
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $63,831
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 number4363IND
Policy instance 5
Insurance contract or identification number4363IND
Number of Individuals Covered46
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $5,649
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $18,616
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 number0004363IN
Policy instance 6
Insurance contract or identification number0004363IN
Number of Individuals Covered9
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $19
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,562
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 number50003921
Policy instance 1
Insurance contract or identification number50003921
Number of Individuals Covered204
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $9,025
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $45,131
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 number0004363IN
Policy instance 2
Insurance contract or identification number0004363IN
Number of Individuals Covered8
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $1,137
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,748
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 number50003921
Policy instance 7
Insurance contract or identification number50003921
Number of Individuals Covered104
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $11,909
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $49,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 8
Insurance contract or identification number221738
Number of Individuals Covered9
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $2
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,844
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 number50003921
Policy instance 3
Insurance contract or identification number50003921
Number of Individuals Covered257
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $193
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,292
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 number0004363IN
Policy instance 9
Insurance contract or identification number0004363IN
Number of Individuals Covered4
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $958
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,598
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 number50003921
Policy instance 4
Insurance contract or identification number50003921
Number of Individuals Covered204
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $310
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,067
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 number4363
Policy instance 1
Insurance contract or identification number4363
Number of Individuals Covered207
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $313
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,701
Commission paid to Insurance BrokerUSD $313
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363
Policy instance 8
Insurance contract or identification number4363
Number of Individuals Covered262
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $190
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,033
Commission paid to Insurance BrokerUSD $190
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363IND
Policy instance 2
Insurance contract or identification number4363IND
Number of Individuals Covered4
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $57
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,135
Commission paid to Insurance BrokerUSD $57
Insurance broker organization code?3
Insurance broker nameHAGAN NEWKIRK FINANCIAL SERVICES
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363IND
Policy instance 3
Insurance contract or identification number4363IND
Number of Individuals Covered9
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $37
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,610
Commission paid to Insurance BrokerUSD $37
Insurance broker organization code?3
Insurance broker nameHAGAN NEWKIRK FINANCIAL SERVICES
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363
Policy instance 4
Insurance contract or identification number4363
Number of Individuals Covered118
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $9,855
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY INCOME PROTECTION
Welfare Benefit Premiums Paid to CarrierUSD $15,955
Commission paid to Insurance BrokerUSD $15
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113282
Policy instance 5
Insurance contract or identification number113282
Number of Individuals Covered15
Insurance policy start date2009-10-01
Insurance policy end date2010-10-01
Total amount of commissions paid to insurance brokerUSD $600
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGROUP LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $4,003
Commission paid to Insurance BrokerUSD $300
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS, INC.
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363IND
Policy instance 7
Insurance contract or identification number4363IND
Number of Individuals Covered2
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $278
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $782
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameDONNIE JOHNSTON
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number221738
Policy instance 9
Insurance contract or identification number221738
Number of Individuals Covered12
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $17
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,717
Commission paid to Insurance BrokerUSD $11
Insurance broker organization code?3
Insurance broker nameAHA INS RESOURCES INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number4363
Policy instance 6
Insurance contract or identification number4363
Number of Individuals Covered133
Insurance policy start date2010-10-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $3,191
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $15,955
Commission paid to Insurance BrokerUSD $798
Insurance broker organization code?3
Insurance broker nameHAROLD CAMPBELL COMPANY

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