OUACHITA COUNTY MEDICAL CENTER VISION CARE PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY
401k plan membership statisitcs for EMPLOYEES' GROUP LIFE INS. & LONG TERM DISABILITY
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 2 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 194 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $32,923 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $136,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,923 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 21 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $1,135 | Total amount of fees paid to insurance company | USD $289 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $5,678 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,135 | Amount paid for insurance broker fees | 289 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 199 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $8,508 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $47,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,508 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 156 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $12,723 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $54,027 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,723 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 2 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 163 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $37,143 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $142,477 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,143 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 63 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $3,332 | Total amount of fees paid to insurance company | USD $821 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $16,643 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,332 | Amount paid for insurance broker fees | 821 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 61 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $3,676 | Total amount of fees paid to insurance company | USD $609 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $18,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,676 | Amount paid for insurance broker fees | 609 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 2 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 172 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $36,915 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $161,810 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,475 | Insurance broker organization code? | 3 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 170 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $10,677 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $54,420 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,346 | Insurance broker organization code? | 3 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $7,949 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $38,983 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 2 |
Insurance contract or identification number | 0356000000 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $28,092 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $122,610 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 78 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,973 | Total amount of fees paid to insurance company | USD $427 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $24,865 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 2 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 181 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $46,562 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $158,605 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,122 | Insurance broker organization code? | 3 |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 140 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $11,608 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $49,057 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,277 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 100 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $3,114 | Total amount of fees paid to insurance company | USD $1,339 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $19,351 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,114 | Amount paid for insurance broker fees | 1339 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 4 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | A2956 |
Policy instance | 1 |
Insurance contract or identification number | A2956 | Number of Individuals Covered | 8 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $268 | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCR,DISAB,HRT/STROKE,TM&UNIV LIFE | Welfare Benefit Premiums Paid to Carrier | USD $5,656 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57 | Insurance broker organization code? | 3 | Insurance broker name | EMPLOYEE BENEFITS INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 2 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 80 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $2,750 | Total amount of fees paid to insurance company | USD $170 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $13,728 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,750 | Amount paid for insurance broker fees | 170 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | JTS FINANCIAL SERVICES |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 3 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 194 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $45,084 | Other welfare benefits provided | UNIVERSAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $110,667 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $45,084 | Insurance broker organization code? | 3 | Insurance broker name | JTS FINANCIAL SERVICES |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 0356000000 |
Policy instance | 4 |
Insurance contract or identification number | 0356000000 | Number of Individuals Covered | 125 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $8,109 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $34,207 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,109 | Insurance broker organization code? | 3 | Insurance broker name | JTS FINANCIAL SERVICES |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000405004057 |
Policy instance | 1 |
Insurance contract or identification number | 000405004057 | Number of Individuals Covered | 88 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $3,991 | Total amount of fees paid to insurance company | USD $2,534 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $19,960 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,991 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2534 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker name | ACUITY GROUP OF MS LLC |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | A2956 |
Policy instance | 2 |
Insurance contract or identification number | A2956 | Number of Individuals Covered | 43 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $999 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29 | Insurance broker organization code? | 3 | Insurance broker name | LEIGH ANN JOHNSON-MACON |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 035600000 |
Policy instance | 3 |
Insurance contract or identification number | 035600000 | Number of Individuals Covered | 94 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $17,226 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $28,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,226 | Insurance broker organization code? | 3 | Insurance broker name | JTS FINANCIAL SERVICES |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | 035600000 |
Policy instance | 4 |
Insurance contract or identification number | 035600000 | Number of Individuals Covered | 118 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $68,587 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $74,998 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $68,587 | Insurance broker organization code? | 3 | Insurance broker name | JTS FINANCIAL SERVICES |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010196185 |
Policy instance | 5 |
Insurance contract or identification number | 000010196185 | Number of Individuals Covered | 101 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $10,026 | Total amount of fees paid to insurance company | USD $3,762 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $66,842 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,026 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3762 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker name | ACUITY GROUP OF MS, LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010196184 |
Policy instance | 7 |
Insurance contract or identification number | 000010196184 | Number of Individuals Covered | 255 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $5,544 | Total amount of fees paid to insurance company | USD $2,179 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,544 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2179 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker name | ACUITY GROUP OF MS, LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010198222 |
Policy instance | 6 |
Insurance contract or identification number | 000010198222 | Number of Individuals Covered | 276 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $1,469 | Total amount of fees paid to insurance company | USD $555 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,469 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 555 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker name | ACUITY GROUP OF MS, LLC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 6 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 256 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $457 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,756 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $422 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 9 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 215 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $16,939 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $70,215 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,792 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 8 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 3 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $2,820 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $521 | Insurance broker organization code? | 3 | Insurance broker name | JEREMY BELL |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 7 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 140 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $4,099 | Other welfare benefits provided | CRITICAL CARE | Welfare Benefit Premiums Paid to Carrier | USD $33,201 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $495 | Insurance broker organization code? | 3 | Insurance broker name | JEFFREY PENNINGTON |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 5 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 136 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $27,475 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $114,417 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,182 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 4 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 134 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $5,139 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $31,076 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,098 | Insurance broker organization code? | 3 | Insurance broker name | JEREMY BELL |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 3 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 692 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $819 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $65,631 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $732 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER SHUMAKE |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 2 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 4 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,624 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 1 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 6 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $19 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,598 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8 | Insurance broker organization code? | 3 | Insurance broker name | JONATHAN ANDERSON |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 3 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 13 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,136 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 5 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 123 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $8,479 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $42,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,120 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 9 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 277 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $112 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $112 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 4 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 124 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $2,133 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $16,688 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $336 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT SAMPLE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 6 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 254 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $330 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $330 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 7 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 3 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $1,591 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,395 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,157 | Insurance broker organization code? | 3 | Insurance broker name | JEREMY BELL |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 1 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 8 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $15 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,901 | 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 | Insurance broker organization code? | 3 | Insurance broker name | JONATHAN ANDERSON |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 8 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 199 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $5,708 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $28,542 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,427 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 2 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 193 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $3,075 | Other welfare benefits provided | CRITICAL CARE | Welfare Benefit Premiums Paid to Carrier | USD $26,477 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $433 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT SAMPLE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 1 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 9 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $19 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,622 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9 | Insurance broker organization code? | 3 | Insurance broker name | JONATHAN ANDERSON |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 9 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 117 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $12,767 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $63,831 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Life Insurance Welfare Benefit | Yes | Commission paid to Insurance Broker | USD $3,192 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 8 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 192 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $12,641 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $39,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,551 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT SAMPLE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 6 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 110 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $3,965 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $22,061 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $608 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT SAMPLE |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 5 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 190 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $11,003 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $55,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,751 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 50003921 |
Policy instance | 4 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 274 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $215 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,136 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $215 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 3 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 13 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $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 number | 50003921 |
Policy instance | 2 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 199 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $263 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,598 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $263 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363IND |
Policy instance | 7 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 2 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $1,810 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $295 | Insurance broker organization code? | 3 | Insurance broker name | ROBERT WESTERMAN |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 0004363IN |
Policy instance | 2 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 192 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $12,641 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 7 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 199 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $263 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,598 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 8 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 9 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $2 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 4363IND |
Policy instance | 6 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 2 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $1,810 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0004363IN |
Policy instance | 4 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 9 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $19 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0004363IN |
Policy instance | 3 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 110 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $3,965 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 1 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 117 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $12,767 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 4363IND |
Policy instance | 5 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 46 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $5,649 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0004363IN |
Policy instance | 6 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 9 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $19 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 1 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 204 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $9,025 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0004363IN |
Policy instance | 2 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 8 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $1,137 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 7 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 104 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $11,909 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $49,623 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 8 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 9 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $2 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 3 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 257 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $193 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 0004363IN |
Policy instance | 9 |
Insurance contract or identification number | 0004363IN | Number of Individuals Covered | 4 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $958 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50003921 |
Policy instance | 4 |
Insurance contract or identification number | 50003921 | Number of Individuals Covered | 204 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $310 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 4363 |
Policy instance | 1 |
Insurance contract or identification number | 4363 | Number of Individuals Covered | 207 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $313 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,701 | Commission paid to Insurance Broker | USD $313 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363 |
Policy instance | 8 |
Insurance contract or identification number | 4363 | Number of Individuals Covered | 262 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $190 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,033 | Commission paid to Insurance Broker | USD $190 | Insurance broker organization code? | 3 | Insurance broker name | CLIFFORD FARMER |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363IND |
Policy instance | 2 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 4 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $57 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,135 | Commission paid to Insurance Broker | USD $57 | Insurance broker organization code? | 3 | Insurance broker name | HAGAN NEWKIRK FINANCIAL SERVICES |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363IND |
Policy instance | 3 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 9 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $37 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,610 | Commission paid to Insurance Broker | USD $37 | Insurance broker organization code? | 3 | Insurance broker name | HAGAN NEWKIRK FINANCIAL SERVICES |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363 |
Policy instance | 4 |
Insurance contract or identification number | 4363 | Number of Individuals Covered | 118 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $9,855 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | Welfare Benefit Premiums Paid to Carrier | USD $15,955 | Commission paid to Insurance Broker | USD $15 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 113282 |
Policy instance | 5 |
Insurance contract or identification number | 113282 | Number of Individuals Covered | 15 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-10-01 | Total amount of commissions paid to insurance broker | USD $600 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GROUP LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $4,003 | Commission paid to Insurance Broker | USD $300 | Insurance broker organization code? | 3 | Insurance broker name | EMPLOYEE BENEFITS, INC. |
|
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363IND |
Policy instance | 7 |
Insurance contract or identification number | 4363IND | Number of Individuals Covered | 2 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $278 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $782 | Commission paid to Insurance Broker | USD $143 | Insurance broker organization code? | 3 | Insurance broker name | DONNIE JOHNSTON |
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PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 ) |
Policy contract number | 221738 |
Policy instance | 9 |
Insurance contract or identification number | 221738 | Number of Individuals Covered | 12 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $17 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,717 | Commission paid to Insurance Broker | USD $11 | Insurance broker organization code? | 3 | Insurance broker name | AHA INS RESOURCES INC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 4363 |
Policy instance | 6 |
Insurance contract or identification number | 4363 | Number of Individuals Covered | 133 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $3,191 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $15,955 | Commission paid to Insurance Broker | USD $798 | Insurance broker organization code? | 3 | Insurance broker name | HAROLD CAMPBELL COMPANY |
|