MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 401k Plan overview

Plan Name	MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST
Plan identification number	504

MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

THE ADMINISTRATIVE COMMITTEE C/O HANCOCK WHITNEY has sponsored the creation of one or more 401k plans.

Company Name:	THE ADMINISTRATIVE COMMITTEE C/O HANCOCK WHITNEY
Employer identification number (EIN):	720995175
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2020-01-01
504	2019-01-01
504	2018-01-01	MONIQUE BRADBERRY	2019-10-10	MONIQUE BRADBERRY	2019-10-10
504	2018-01-01
504	2017-01-01
504	2017-01-01
504	2017-01-01
504	2016-01-01
504	2016-01-01
504	2015-01-01
504	2015-01-01
504	2014-01-01
504	2014-01-01
504	2013-01-01
504	2013-01-01
504	2012-01-01	TERI S STELLY		TERI S STELLY	2013-10-11
504	2012-01-01
504	2011-01-01	TERI S STELLY		TERI S STELLY	2012-10-12
504	2011-01-01
504	2010-01-01
504	2009-01-01	TERI STELLY		TERI STELLY	2010-10-08
504	2009-01-01

Plan Statistics for MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST

401k plan membership statisitcs for MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST

Measure	Date	Value
2020: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
2019: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	430
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
2018: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	452
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	452
Total of all active and inactive participants	2018-01-01	452
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
2017: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	499
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	499
Total of all active and inactive participants	2017-01-01	499
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
2016: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	546
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	546
Total of all active and inactive participants	2016-01-01	546
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	546
2015: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	559
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	559
Total of all active and inactive participants	2015-01-01	559
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
2014: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	573
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	573
Total of all active and inactive participants	2014-01-01	573
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
2013: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	639
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	639
Total of all active and inactive participants	2013-01-01	639
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
2012: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	487
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	487
Total of all active and inactive participants	2012-01-01	487
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
2011: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	425
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	425
2010: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	387
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	370
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	370
2009: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	359
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	387
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	387
Total participants	2009-01-01	0

Financial Data on MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST

Measure	Date	Value
2018 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$431,788
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$520,749
Total income from all sources (including contributions)	2018-12-31	$4,871,801
Total of all expenses incurred	2018-12-31	$4,705,439
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$4,406,564
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$4,871,801
Value of total assets at end of year	2018-12-31	$250,151
Value of total assets at beginning of year	2018-12-31	$172,750
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$298,875
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,417,535
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$1,076,901
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$248,422
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$113,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$1,926
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$0
Liabilities. Value of operating payables at end of year	2018-12-31	$2,931
Total non interest bearing cash at end of year	2018-12-31	$1,729
Total non interest bearing cash at beginning of year	2018-12-31	$59,606
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$166,362
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$-181,637
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$-347,999
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$1,117,412
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$2,377,365
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$3,289,152
Contract administrator fees	2018-12-31	$298,875
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$426,931
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$520,749
Did the plan have assets held for investment	2018-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	KOLDER,SLAVEN & CO, INC
Accountancy firm EIN	2018-12-31	721369868
2017 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$467,160
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$467,832
Total income from all sources (including contributions)	2017-12-31	$4,894,404
Total of all expenses incurred	2017-12-31	$4,798,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$4,434,319
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$4,894,404
Value of total assets at end of year	2017-12-31	$114,425
Value of total assets at beginning of year	2017-12-31	$18,918
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$363,906
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$363,906
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$1,591,551
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$539,858
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$54,819
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$18,918
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$672
Total non interest bearing cash at end of year	2017-12-31	$59,606
Total non interest bearing cash at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$96,179
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$-352,735
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$-448,914
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$1,219,753
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$2,762,995
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$3,214,566
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$467,160
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$467,160
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	KOLDER,SLAVEN & CO, INC
Accountancy firm EIN	2017-12-31	721369868
2016 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$467,832
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$565,467
Total income from all sources (including contributions)	2016-12-31	$4,789,046
Total of all expenses incurred	2016-12-31	$4,981,105
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$4,556,182
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$4,789,046
Value of total assets at end of year	2016-12-31	$18,918
Value of total assets at beginning of year	2016-12-31	$308,612
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$424,923
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$377,320
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,490,817
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$960,600
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$18,918
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$294,686
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$672
Administrative expenses (other) incurred	2016-12-31	$47,603
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$13,926
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-192,059
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$-448,914
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$-256,855
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$742,391
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$2,337,629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$3,813,791
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$467,160
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$565,467
Did the plan have assets held for investment	2016-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2016-12-31	721369868
2015 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$565,467
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$292,891
Total income from all sources (including contributions)	2015-12-31	$4,205,867
Total of all expenses incurred	2015-12-31	$4,321,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$3,967,509
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$4,205,867
Value of total assets at end of year	2015-12-31	$308,612
Value of total assets at beginning of year	2015-12-31	$151,710
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$354,032
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$330,671
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,348,635
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$615,034
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$294,686
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$77,946
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$23,361
Total non interest bearing cash at end of year	2015-12-31	$13,926
Total non interest bearing cash at beginning of year	2015-12-31	$73,764
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-115,674
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$-256,855
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$-141,181
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$732,685
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$2,242,198
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$3,234,824
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$565,467
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$292,891
Did the plan have assets held for investment	2015-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2015-12-31	721369868
2014 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$292,891
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$240,201
Total income from all sources (including contributions)	2014-12-31	$4,291,368
Total of all expenses incurred	2014-12-31	$4,235,036
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$3,854,005
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$4,291,368
Value of total assets at end of year	2014-12-31	$151,710
Value of total assets at beginning of year	2014-12-31	$42,688
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$381,031
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$353,871
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,336,200
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$226,050
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$77,946
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$7,688
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$6,083
Administrative expenses (other) incurred	2014-12-31	$27,160
Total non interest bearing cash at end of year	2014-12-31	$73,764
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$56,332
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$-141,181
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$-197,513
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$822,669
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$2,729,118
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$35,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$3,031,336
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$292,891
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$234,118
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2014-12-31	721369868
2013 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$240,201
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$701,973
Total income from all sources (including contributions)	2013-12-31	$3,559,728
Total of all expenses incurred	2013-12-31	$3,585,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$3,234,160
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$3,559,728
Value of total assets at end of year	2013-12-31	$42,688
Value of total assets at beginning of year	2013-12-31	$530,148
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$351,256
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$351,256
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$600,000
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,356,660
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$76,285
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$7,688
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$512,072
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$6,083
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$18,076
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-25,688
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$-197,513
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$-171,825
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$814,410
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$2,126,783
Employer contributions (assets) at end of year	2013-12-31	$35,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$2,419,750
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$234,118
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$701,973
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2013-12-31	721369868
2012 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$701,973
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$90,326
Total income from all sources (including contributions)	2012-12-31	$2,635,120
Total of all expenses incurred	2012-12-31	$2,818,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,558,660
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,635,120
Value of total assets at end of year	2012-12-31	$530,148
Value of total assets at beginning of year	2012-12-31	$101,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$259,351
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$600,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$948,560
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$517,910
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$512,072
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$18,076
Total non interest bearing cash at beginning of year	2012-12-31	$101,392
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-182,891
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$-171,825
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$11,066
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$537,891
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$1,168,650
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$2,020,769
Contract administrator fees	2012-12-31	$259,351
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$701,973
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$90,326
Did the plan have assets held for investment	2012-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2012-12-31	721369868
2011 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$90,326
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$150,395
Total income from all sources (including contributions)	2011-12-31	$1,890,204
Total of all expenses incurred	2011-12-31	$1,803,712
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,597,448
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,890,204
Value of total assets at end of year	2011-12-31	$101,392
Value of total assets at beginning of year	2011-12-31	$74,969
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$206,264
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$206,264
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$600,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$828,340
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$6,091
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$56,191
Total non interest bearing cash at end of year	2011-12-31	$101,392
Total non interest bearing cash at beginning of year	2011-12-31	$18,778
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$86,492
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$11,066
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$-75,426
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$437,116
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$1,055,773
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,160,332
Contract administrator fees	2011-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$90,326
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$150,395
Did the plan have assets held for investment	2011-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2011-12-31	721369868
2010 : MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$150,395
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$199,206
Total income from all sources (including contributions)	2010-12-31	$1,937,040
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$2,014,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,811,878
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,937,040
Value of total assets at end of year	2010-12-31	$74,969
Value of total assets at beginning of year	2010-12-31	$201,699
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$203,081
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$203,081
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$600,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$823,202
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$98,028
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$56,191
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$136,955
Total non interest bearing cash at end of year	2010-12-31	$18,778
Total non interest bearing cash at beginning of year	2010-12-31	$64,744
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-77,919
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$-75,426
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,493
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$434,640
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$1,015,810
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,377,238
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$150,395
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$199,206
Did the plan have assets held for investment	2010-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	KOLDER, CHAMPAGNE, SLAVEN & CO, INC
Accountancy firm EIN	2010-12-31	721369868

Form 5500 Responses for MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST

2020: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MIDSOUTH NATIONAL BANK EMPLOYEE BENEFIT PLAN TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	4
Insurance contract or identification number 78754ERC Number of Individuals Covered 640 Insurance policy start date 2019-01-01 Insurance policy end date 2019-09-30 Total amount of commissions paid to insurance broker USD $32,130 Total amount of fees paid to insurance company USD $20,799 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,130 Amount paid for insurance broker fees 20799 Additional information about fees paid to insurance broker INDIRECT COMPENSATION Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010236969000
Policy instance	5
Insurance contract or identification number 000010236969000 Number of Individuals Covered 266 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $2,505 Total amount of fees paid to insurance company USD $132 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $25,046 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,505 Insurance broker organization code? 3 Amount paid for insurance broker fees 132 Additional information about fees paid to insurance broker FEES
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	405694-0010
Policy instance	3
Insurance contract or identification number 405694-0010 Number of Individuals Covered 360 Insurance policy start date 2019-01-01 Insurance policy end date 2019-09-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $604,806 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1072598
Policy instance	2
Insurance contract or identification number 1072598 Number of Individuals Covered 353 Insurance policy start date 2019-01-01 Insurance policy end date 2019-09-30 Total amount of commissions paid to insurance broker USD $33,758 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $119,361 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,785 Insurance broker organization code? 3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	0000024093
Policy instance	7
Insurance contract or identification number 0000024093 Number of Individuals Covered 162 Insurance policy start date 2019-01-01 Insurance policy end date 2019-09-30 Total amount of commissions paid to insurance broker USD $17,160 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT,CRITICAL ILL, CANCER,HOSPL Welfare Benefit Premiums Paid to Carrier USD $31,820 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,580 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	0001D0361590000
Policy instance	6
Insurance contract or identification number 0001D0361590000 Number of Individuals Covered 300 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $12,368 Total amount of fees paid to insurance company USD $1,985 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $164,902 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,368 Insurance broker organization code? 3 Amount paid for insurance broker fees 1985 Additional information about fees paid to insurance broker BROKER BONUS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 430 Insurance policy start date 2019-01-01 Insurance policy end date 2019-09-30 Total amount of commissions paid to insurance broker USD $11,787 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,721 Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	7
Insurance contract or identification number 78754ERC Number of Individuals Covered 377 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $39,951 Total amount of fees paid to insurance company USD $21,598 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,951 Amount paid for insurance broker fees 21598 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010236969000
Policy instance	1
Insurance contract or identification number 000010236969000 Number of Individuals Covered 253 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,653 Total amount of fees paid to insurance company USD $572 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,653 Insurance broker organization code? 3 Amount paid for insurance broker fees 572 Additional information about fees paid to insurance broker BROKER BONUS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 452 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,814 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,347 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00001D036159000
Policy instance	3
Insurance contract or identification number 00001D036159000 Number of Individuals Covered 319 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,799 Total amount of fees paid to insurance company USD $4,345 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $197,316 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,799 Insurance broker organization code? 3 Amount paid for insurance broker fees 4345 Additional information about fees paid to insurance broker BROKER BONUS
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	0000024093
Policy instance	4
Insurance contract or identification number 0000024093 Number of Individuals Covered 162 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $21,476 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS, CANCER, HOSPITALIZATION Welfare Benefit Premiums Paid to Carrier USD $31,803 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,738 Insurance broker organization code? 3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1072598
Policy instance	5
Insurance contract or identification number 1072598 Number of Individuals Covered 191 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $18,187 Total amount of fees paid to insurance company USD $7,213 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $156,347 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,187 Amount paid for insurance broker fees 7213 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	0000024093
Policy instance	7
Insurance contract or identification number 0000024093 Number of Individuals Covered 162 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $21,476 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT, CRITICAL ILL,CANCER,HOSPL Welfare Benefit Premiums Paid to Carrier USD $31,803 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,738 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010236969000
Policy instance	5
Insurance contract or identification number 000010236969000 Number of Individuals Covered 253 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,653 Total amount of fees paid to insurance company USD $572 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,653 Insurance broker organization code? 3 Amount paid for insurance broker fees 572 Additional information about fees paid to insurance broker BROKER BONUS
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	4
Insurance contract or identification number 78754ERC Number of Individuals Covered 377 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $39,951 Total amount of fees paid to insurance company USD $21,598 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,951 Amount paid for insurance broker fees 21598 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	405694-0010
Policy instance	3
Insurance contract or identification number 405694-0010 Number of Individuals Covered 371 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,532 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $636,329 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,266 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 452 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,814 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,467 Insurance broker organization code? 1
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1072598
Policy instance	2
Insurance contract or identification number 1072598 Number of Individuals Covered 191 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $18,187 Total amount of fees paid to insurance company USD $7,213 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $156,347 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,187 Amount paid for insurance broker fees 7213 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	00001D036159000
Policy instance	6
Insurance contract or identification number 00001D036159000 Number of Individuals Covered 319 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $14,799 Total amount of fees paid to insurance company USD $4,345 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $197,316 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,799 Insurance broker organization code? 3 Amount paid for insurance broker fees 4345 Additional information about fees paid to insurance broker BROKER BONUS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	405694-0010
Policy instance	6
Insurance contract or identification number 405694-0010 Number of Individuals Covered 371 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,532 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $636,329 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,266 Insurance broker organization code? 3
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number	MSBK117
Policy instance	6
Insurance contract or identification number MSBK117 Number of Individuals Covered 353 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $19,615 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $246,286 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,940 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 499 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $15,198 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,156 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 99 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $8,475 Total amount of fees paid to insurance company USD $419 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $67,042 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $308 Insurance broker organization code? 3 Amount paid for insurance broker fees 299 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker name GARY KLEIN
CONSECO ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60682 )
Policy contract number	VP500
Policy instance	3
Insurance contract or identification number VP500 Number of Individuals Covered 1 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $80 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15 Insurance broker organization code? 3 Insurance broker name CHARLES H AVERY JR
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1072598
Policy instance	4
Insurance contract or identification number 1072598 Number of Individuals Covered 213 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $18,028 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $151,455 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,582 Insurance broker organization code? 3 Insurance broker name ASSURED PARTNERS GULF COAST INS AGY
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	405694-0010
Policy instance	5
Insurance contract or identification number 405694-0010 Number of Individuals Covered 415 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $17,890 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $615,084 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,864 Insurance broker organization code? 3 Insurance broker name ST HEALTH BENEFITS SLTNS
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	7
Insurance contract or identification number 78754ERC Number of Individuals Covered 409 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $35,931 Total amount of fees paid to insurance company USD $12,255 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,293 Amount paid for insurance broker fees 12255 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	8
Insurance contract or identification number E3862224 Number of Individuals Covered 18 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,056 Total amount of fees paid to insurance company USD $22 Other welfare benefits provided ACCIDENT, CANCER, HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $19,996 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $751 Amount paid for insurance broker fees 21 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3 Insurance broker name BETTY ROMERO
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 25 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $478 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,562 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $478 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	7
Insurance contract or identification number E3862224 Number of Individuals Covered 22 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $4,519 Total amount of fees paid to insurance company USD $1,079 Other welfare benefits provided ACCIDENT, CANCER, HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $21,153 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,952 Amount paid for insurance broker fees 777 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3 Insurance broker name ASSURED PARTNERS GULF COAST INSURAN
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 213 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $10,930 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $72,869 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,930 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 234 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $10,944 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,960 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,944 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
CONSECO ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60682 )
Policy contract number	VP500
Policy instance	4
Insurance contract or identification number VP500 Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $80 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15 Insurance broker organization code? 3 Insurance broker name KENNETH J BRYANT
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 559 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $15,787 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,487 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 451 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $47,974 Total amount of fees paid to insurance company USD $9,390 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $47,974 Amount paid for insurance broker fees 9390 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	5
Insurance contract or identification number 78754ERC Number of Individuals Covered 451 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $47,974 Total amount of fees paid to insurance company USD $9,390 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $47,974 Amount paid for insurance broker fees 9390 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3
CONSECO ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60682 )
Policy contract number	VP500
Policy instance	8
Insurance contract or identification number VP500 Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $80 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181 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 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	6
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 25 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $478 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,562 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $478 Insurance broker organization code? 3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 152 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $11,338 Total amount of fees paid to insurance company USD $728 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $88,995 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $499 Insurance broker organization code? 3 Amount paid for insurance broker fees 358 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker name ERIC MILLER
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	4
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 234 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $10,944 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,960 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,944 Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	7
Insurance contract or identification number 78754ERC Number of Individuals Covered 457 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $56,680 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,029,265 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,680 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	6
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 244 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $10,592 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $70,616 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,592 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	402728 0010
Policy instance	5
Insurance contract or identification number 402728 0010 Number of Individuals Covered 470 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $11,579 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $463,157 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,579 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, LLC
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	8
Insurance contract or identification number MDS110D Number of Individuals Covered 410 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $4,127 Total amount of fees paid to insurance company USD $2,553 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $236,741 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,127 Amount paid for insurance broker fees 2553 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
CONSECO ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60682 )
Policy contract number	VP500
Policy instance	4
Insurance contract or identification number VP500 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $27 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181 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 Insurance broker organization code? 3 Insurance broker name CHARLES AVERY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 238 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $10,668 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $71,118 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,668 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 177 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $19,452 Total amount of fees paid to insurance company USD $177 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $108,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $763 Insurance broker organization code? 3 Amount paid for insurance broker fees 34 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker name THOMAS MONTGOMERY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 573 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $14,389 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,389 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	9
Insurance contract or identification number E3862224 Number of Individuals Covered 11 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $1,254 Total amount of fees paid to insurance company USD $384 Other welfare benefits provided ACCIDENT, CANCER, HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $15,407 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $754 Amount paid for insurance broker fees 302 Additional information about fees paid to insurance broker BONUS/INCENTIVES Insurance broker organization code? 3 Insurance broker name ASSURED PARTNERS GULF COAST INSURAN
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 177 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $19,452 Total amount of fees paid to insurance company USD $177 Other welfare benefits provided CANCER,ACCID.INT CARE,HOSP,SPEC E, Welfare Benefit Premiums Paid to Carrier USD $108,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,284 Amount paid for insurance broker fees 34 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 244 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $10,592 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $70,616 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,592 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 573 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $14,389 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,389 Insurance broker organization code? 3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4027280010
Policy instance	1
Insurance contract or identification number 4027280010 Number of Individuals Covered 470 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $11,579 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $463,157 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,579 Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 457 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $56,680 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,029,265 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,680 Insurance broker organization code? 3
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	7
Insurance contract or identification number MDS110D Number of Individuals Covered 410 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $4,127 Total amount of fees paid to insurance company USD $2,553 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $236,741 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,127 Amount paid for insurance broker fees 2553 Additional information about fees paid to insurance broker BONUS/INCENTIVE Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 28 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $475 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,493 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $475 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	10
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 28 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $475 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,493 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $475 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
CONSECO ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60682 )
Policy contract number	VP500
Policy instance	10
Insurance contract or identification number VP500 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $27 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181 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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	4
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 238 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $10,668 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $71,118 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,668 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 639 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,931 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,931 Insurance broker organization code? 3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	9
Insurance contract or identification number E3862224 Number of Individuals Covered 12 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $1,350 Total amount of fees paid to insurance company USD $318 Other welfare benefits provided ACCIDENT,CANCER,HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $14,249 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $820 Amount paid for insurance broker fees 208 Additional information about fees paid to insurance broker BONUS-INCENTIVES Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 53 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $924 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,474 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $924 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	4
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 262 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $10,851 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $72,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,851 Insurance broker organization code? 3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4027280010
Policy instance	1
Insurance contract or identification number 4027280010 Number of Individuals Covered 477 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $11,041 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $441,641 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,041 Insurance broker organization code? 3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 221 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $17,182 Total amount of fees paid to insurance company USD $205 Other welfare benefits provided CANCER,ACCID.INT CARE,HOSP,SPEC E, Welfare Benefit Premiums Paid to Carrier USD $110,490 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,675 Amount paid for insurance broker fees 64 Additional information about fees paid to insurance broker BONUS-INCENTIVE Insurance broker organization code? 3
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	7
Insurance contract or identification number MDS110D Number of Individuals Covered 443 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $3,799 Total amount of fees paid to insurance company USD $2,600 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $403,005 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,799 Amount paid for insurance broker fees 2600 Additional information about fees paid to insurance broker BROKER FEE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	9
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 53 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $924 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,474 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $924 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	8
Insurance contract or identification number E3862224 Number of Individuals Covered 12 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $1,350 Total amount of fees paid to insurance company USD $318 Other welfare benefits provided ACCIDENT, CANCER, HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $14,249 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $820 Amount paid for insurance broker fees 208 Additional information about fees paid to insurance broker BONUS-INCENTIVE Insurance broker organization code? 3 Insurance broker name TIFFANY BOURGEOIS-HOLMES
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 495 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $59,120 Total amount of fees paid to insurance company USD $5,466 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $59,120 Amount paid for insurance broker fees 5466 Additional information about fees paid to insurance broker BONUS-INCENTIVE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 276 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $10,889 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $72,596 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,889 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	402728 0010
Policy instance	4
Insurance contract or identification number 402728 0010 Number of Individuals Covered 477 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $11,041 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $441,641 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,041 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 262 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $10,851 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $72,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,851 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 221 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $17,182 Total amount of fees paid to insurance company USD $205 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $110,490 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,385 Insurance broker organization code? 3 Amount paid for insurance broker fees 26 Additional information about fees paid to insurance broker BONUS-INCENTIVE Insurance broker name THOMAS MONTGOMERY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 639 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,931 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,931 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	9
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 25 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $476 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $476 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 487 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $9,115 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,115 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 98 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $9,941 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $68,981 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,128 Insurance broker organization code? 3 Insurance broker name THOMAS MONTGOMERY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 144 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,415 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $42,765 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,415 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	402728 0010
Policy instance	4
Insurance contract or identification number 402728 0010 Number of Individuals Covered 372 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $7,743 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $309,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,743 Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY, LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	9
Insurance contract or identification number E3862224 Number of Individuals Covered 13 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $1,832 Total amount of fees paid to insurance company USD $604 Other welfare benefits provided ACCIDENT,CANCER,HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $13,733 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,140 Amount paid for insurance broker fees 399 Additional information about fees paid to insurance broker BONUS-INCENTIVES Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 25 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $476 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $476 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	4
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 144 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,415 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $42,765 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,415 Insurance broker organization code? 3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 98 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $9,941 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided CANCER,ACCID.INT CARE,HOSP,SPEC E, Welfare Benefit Premiums Paid to Carrier USD $68,981 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,197 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 487 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $9,115 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,115 Insurance broker organization code? 3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4027280010
Policy instance	1
Insurance contract or identification number 4027280010 Number of Individuals Covered 372 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $7,743 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $309,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,743 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 146 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,103 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $40,685 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,103 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 390 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $3,920 Total amount of fees paid to insurance company USD $3,408 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,920 Amount paid for insurance broker fees 3408 Additional information about fees paid to insurance broker BONUS-INCENTIVE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E3862224
Policy instance	8
Insurance contract or identification number E3862224 Number of Individuals Covered 13 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $1,832 Total amount of fees paid to insurance company USD $604 Other welfare benefits provided ACCIDENT, CANCER, HOSP CONFINEMENT Welfare Benefit Premiums Paid to Carrier USD $13,733 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,140 Amount paid for insurance broker fees 399 Additional information about fees paid to insurance broker BONUS-INCENTIVES Insurance broker organization code? 3 Insurance broker name MICHAEL J ROBICHEAUX
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	7
Insurance contract or identification number MDS110D Number of Individuals Covered 331 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $2,737 Total amount of fees paid to insurance company USD $1,876 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $168,380 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,737 Amount paid for insurance broker fees 1876 Additional information about fees paid to insurance broker BROKER FEE Insurance broker organization code? 3 Insurance broker name PAUL'S AGENCY
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 112 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $18,322 Total amount of fees paid to insurance company USD $875 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $81,793 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 112 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $18,322 Total amount of fees paid to insurance company USD $875 Other welfare benefits provided CANCER,ACCID.INT CARE,HOSP,SPEC E, Welfare Benefit Premiums Paid to Carrier USD $81,793 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,413 Amount paid for insurance broker fees 272 Additional information about fees paid to insurance broker BONUS, INCENTIVE Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 425 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $2,901 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 126 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,086 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $34,832 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4027280010
Policy instance	1
Insurance contract or identification number 4027280010 Number of Individuals Covered 329 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,534 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $261,357 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,534 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 425 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $2,901 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,901 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	4
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 126 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,086 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $34,832 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,086 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPROAF6E
Policy instance	5
Insurance contract or identification number GUPROAF6E Number of Individuals Covered 135 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,655 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $38,386 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,655 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 17 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $492 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,949 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $492 Insurance broker organization code? 3
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	7
Insurance contract or identification number MDS110D Number of Individuals Covered 289 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $2,537 Total amount of fees paid to insurance company USD $1,588 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $131,408 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,537 Amount paid for insurance broker fees 1588 Additional information about fees paid to insurance broker BONUS, INCENTIVE Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 319 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $2,502 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 2502 Additional information about fees paid to insurance broker BONUS, INCENTIVE Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 135 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,655 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $38,386 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	402728 0010
Policy instance	4
Insurance contract or identification number 402728 0010 Number of Individuals Covered 329 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,534 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $261,357 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	1
Insurance contract or identification number 123495 Number of Individuals Covered 370 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,960 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,960 Insurance broker organization code? 3 Insurance broker name PAUL S AGENCY, INC.
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4027280010
Policy instance	1
Insurance contract or identification number 4027280010 Number of Individuals Covered 318 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $6,538 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $261,504 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,538 Insurance broker organization code? 3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 153 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $19,962 Total amount of fees paid to insurance company USD $1,117 Other welfare benefits provided CANCER,ACCID.INT CARE,HOSP,SPEC E, Welfare Benefit Premiums Paid to Carrier USD $85,010 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,315 Amount paid for insurance broker fees 375 Additional information about fees paid to insurance broker BONUS AND INCENTIVES Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	4
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 118 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $5,028 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $33,520 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,028 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPROAF6E
Policy instance	5
Insurance contract or identification number GUPROAF6E Number of Individuals Covered 143 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $5,591 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,274 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,591 Insurance broker organization code? 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUC0AF6E
Policy instance	8
Insurance contract or identification number GUC0AF6E Number of Individuals Covered 14 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $231 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,613 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $231 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number	MDS110D
Policy instance	7
Insurance contract or identification number MDS110D Number of Individuals Covered 343 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $912 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $112,180 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $912 Insurance broker organization code? 3 Insurance broker name PAUL S AGENCY
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 370 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,960 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,960 Insurance broker organization code? 3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	2
Insurance contract or identification number 59649 Number of Individuals Covered 153 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $19,962 Total amount of fees paid to insurance company USD $1,117 Other welfare benefits provided CANCER,ACCID,INT CARE,HOSP,SPEC EVE Welfare Benefit Premiums Paid to Carrier USD $85,010 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,315 Amount paid for insurance broker fees 375 Additional information about fees paid to insurance broker BONUS AND INCENTIVES Insurance broker organization code? 3 Insurance broker name EDWARD OLIVIER
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AF6E
Policy instance	3
Insurance contract or identification number GVTL0AF6E Number of Individuals Covered 118 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $5,028 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $33,520 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,028 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	402728 0010
Policy instance	4
Insurance contract or identification number 402728 0010 Number of Individuals Covered 318 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $6,538 Total amount of fees paid to insurance company USD $0 Welfare Benefit Premiums Paid to Carrier USD $261,504 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,538 Insurance broker organization code? 3 Insurance broker name PAUL S AGENCY, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUPR0AF6E
Policy instance	5
Insurance contract or identification number GUPR0AF6E Number of Individuals Covered 143 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $5,591 Total amount of fees paid to insurance company USD $0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,274 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,591 Insurance broker organization code? 3 Insurance broker name LANDRY HARRIS AND CO LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number	78754ERC
Policy instance	6
Insurance contract or identification number 78754ERC Number of Individuals Covered 351 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $680 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $680 Insurance broker organization code? 3 Insurance broker name PAUL S AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	UP75A8
Policy instance	4
Insurance contract or identification number UP75A8 Number of Individuals Covered 345 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $37,856 Total amount of fees paid to insurance company USD $42,278 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $310,561 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $37,856 Insurance broker organization code? 3 Amount paid for insurance broker fees 21769 Additional information about fees paid to insurance broker PPO FEE
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	59649
Policy instance	3
Insurance contract or identification number 59649 Number of Individuals Covered 154 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $21,891 Total amount of fees paid to insurance company USD $1,237 Other welfare benefits provided MISC HEALTH Welfare Benefit Premiums Paid to Carrier USD $78,970 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,895 Amount paid for insurance broker fees 311 Additional information about fees paid to insurance broker FEES AND BONUSES Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	123495
Policy instance	2
Insurance contract or identification number 123495 Number of Individuals Covered 387 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $4,596 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,596 Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	KM05585997
Policy instance	1
Insurance contract or identification number KM05585997 Number of Individuals Covered 274 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $10,466 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $76,848 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,680 Insurance broker organization code? 3