401k Plan data: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN plan

MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 401k Plan overview

Plan Name	MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN
Plan identification number	001

MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MCCURTAIN COUNTY BANCSHARES, INC. has sponsored the creation of one or more 401k plans.

Company Name: MCCURTAIN COUNTY BANCSHARES, INC.

Employer identification number (EIN): 731141602

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JOHN CALLAHAM 2023-03-17
001 2021-01-01 JOHN CALLAHAM 2022-05-23
001 2020-01-01 JOHN CALLAHAM 2021-03-08
001 2020-01-01 JOHN CALLAHAM 2021-04-28
001 2018-01-01 JOHN CALLAHAM 2019-01-22
001 2017-01-01 JOHN CALLAHAM 2018-06-18
001 2016-01-01 JOHN CALLAHAM
001 2015-01-01 JOHN CALLAHAM
001 2014-01-01 JOHN CALLAHAM
001 2013-01-01 JOHN CALLAHAM
001 2012-01-01 JOHN CALLAHAM
001 2011-01-01 JOHN CALLAHAM
001 2009-01-01 JOHN CALLAHAM

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	JOHN CALLAHAM	2023-03-17
001	2021-01-01	JOHN CALLAHAM	2022-05-23
001	2020-01-01	JOHN CALLAHAM	2021-03-08
001	2020-01-01	JOHN CALLAHAM	2021-04-28
001	2018-01-01	JOHN CALLAHAM	2019-01-22
001	2017-01-01	JOHN CALLAHAM	2018-06-18
001	2016-01-01	JOHN CALLAHAM
001	2015-01-01	JOHN CALLAHAM
001	2014-01-01	JOHN CALLAHAM
001	2013-01-01	JOHN CALLAHAM
001	2012-01-01	JOHN CALLAHAM
001	2011-01-01	JOHN CALLAHAM
001	2009-01-01	JOHN CALLAHAM

Plan Statistics for MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN

401k plan membership statisitcs for MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN

Measure Date Value
2016: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 36
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 7
Total of all active and inactive participants 2016-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 47
Number of participants with account balances 2016-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 37
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 6
Total of all active and inactive participants 2015-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 46
Number of participants with account balances 2015-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 33
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 42
Number of participants with account balances 2014-01-01 0
2013: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 31
Number of retired or separated participants receiving benefits 2013-01-01 9
Number of other retired or separated participants entitled to future benefits 2013-01-01 8
Total of all active and inactive participants 2013-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 48
Number of participants with account balances 2013-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 38
Number of retired or separated participants receiving benefits 2012-01-01 6
Number of other retired or separated participants entitled to future benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 47
Number of participants with account balances 2012-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 41
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 6
Total of all active and inactive participants 2011-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 47
Number of participants with account balances 2011-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 36
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 41
Number of participants with account balances 2009-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	36
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	7
Total of all active and inactive participants	2016-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	47
Number of participants with account balances	2016-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	37
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	6
Total of all active and inactive participants	2015-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	46
Number of participants with account balances	2015-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	33
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	42
Number of participants with account balances	2014-01-01	0
2013: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	31
Number of retired or separated participants receiving benefits	2013-01-01	9
Number of other retired or separated participants entitled to future benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	48
Number of participants with account balances	2013-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	38
Number of retired or separated participants receiving benefits	2012-01-01	6
Number of other retired or separated participants entitled to future benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	47
Number of participants with account balances	2012-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	41
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	6
Total of all active and inactive participants	2011-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	47
Number of participants with account balances	2011-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	36
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	41
Number of participants with account balances	2009-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN

Measure	Date	Value
2016 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$182,992
Expenses. Total of all expenses incurred	2016-12-31	$23,037
Benefits paid (including direct rollovers)	2016-12-31	$23,037
Total plan assets at end of year	2016-12-31	$1,742,469
Total plan assets at beginning of year	2016-12-31	$1,582,514
Value of fidelity bond covering the plan	2016-12-31	$2,050,000
Total contributions received or receivable from participants	2016-12-31	$37,668
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$97,489
Net income (gross income less expenses)	2016-12-31	$159,955
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,742,469
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,582,514
Total contributions received or receivable from employer(s)	2016-12-31	$47,835
Value of certain deemed distributions of participant loans	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
2015 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$65,563
Expenses. Total of all expenses incurred	2015-12-31	$15,910
Benefits paid (including direct rollovers)	2015-12-31	$15,910
Total plan assets at end of year	2015-12-31	$1,582,514
Total plan assets at beginning of year	2015-12-31	$1,532,861
Value of fidelity bond covering the plan	2015-12-31	$2,050,000
Total contributions received or receivable from participants	2015-12-31	$36,455
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-23,055
Net income (gross income less expenses)	2015-12-31	$49,653
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,582,514
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,532,861
Total contributions received or receivable from employer(s)	2015-12-31	$52,163
Value of certain deemed distributions of participant loans	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
2014 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$138,717
Expenses. Total of all expenses incurred	2014-12-31	$25,039
Benefits paid (including direct rollovers)	2014-12-31	$25,039
Total plan assets at end of year	2014-12-31	$1,532,861
Total plan assets at beginning of year	2014-12-31	$1,419,183
Value of fidelity bond covering the plan	2014-12-31	$2,050,000
Total contributions received or receivable from participants	2014-12-31	$34,115
Other income received	2014-12-31	$56,867
Net income (gross income less expenses)	2014-12-31	$113,678
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,532,861
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,419,183
Total contributions received or receivable from employer(s)	2014-12-31	$47,735
2013 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$266,997
Expenses. Total of all expenses incurred	2013-12-31	$50,069
Benefits paid (including direct rollovers)	2013-12-31	$50,069
Total plan assets at end of year	2013-12-31	$1,419,183
Total plan assets at beginning of year	2013-12-31	$1,202,255
Value of fidelity bond covering the plan	2013-12-31	$2,050,000
Total contributions received or receivable from participants	2013-12-31	$32,938
Other income received	2013-12-31	$185,881
Net income (gross income less expenses)	2013-12-31	$216,928
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,419,183
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,202,255
Total contributions received or receivable from employer(s)	2013-12-31	$48,178
2012 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$176,755
Expenses. Total of all expenses incurred	2012-12-31	$71,214
Benefits paid (including direct rollovers)	2012-12-31	$71,214
Total plan assets at end of year	2012-12-31	$1,202,255
Total plan assets at beginning of year	2012-12-31	$1,096,714
Value of fidelity bond covering the plan	2012-12-31	$2,050,000
Total contributions received or receivable from participants	2012-12-31	$31,739
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$97,205
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$105,541
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,202,255
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,096,714
Total contributions received or receivable from employer(s)	2012-12-31	$47,811
2011 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$47,975
Expenses. Total of all expenses incurred	2011-12-31	$59,038
Benefits paid (including direct rollovers)	2011-12-31	$54,190
Total plan assets at end of year	2011-12-31	$1,096,714
Total plan assets at beginning of year	2011-12-31	$1,107,777
Value of fidelity bond covering the plan	2011-12-31	$2,050,000
Total contributions received or receivable from participants	2011-12-31	$31,699
Other income received	2011-12-31	$-27,959
Net income (gross income less expenses)	2011-12-31	$-11,063
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,096,714
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,107,777
Total contributions received or receivable from employer(s)	2011-12-31	$44,235
Value of corrective distributions	2011-12-31	$4,848
2010 : MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$158,030
Expenses. Total of all expenses incurred	2010-12-31	$11,230
Benefits paid (including direct rollovers)	2010-12-31	$11,230
Total plan assets at end of year	2010-12-31	$1,107,777
Total plan assets at beginning of year	2010-12-31	$960,977
Value of fidelity bond covering the plan	2010-12-31	$2,050,000
Total contributions received or receivable from participants	2010-12-31	$30,057
Other income received	2010-12-31	$76,675
Net income (gross income less expenses)	2010-12-31	$146,800
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,107,777
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$960,977
Total contributions received or receivable from employer(s)	2010-12-31	$51,298

Form 5500 Responses for MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN

2016: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: MCCURTAIN COUNTY NATIONAL BANK 401(K)/PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

87180458

Policy instance

Insurance contract or identification number	87180458
Number of Individuals Covered	42
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $881
Are there contracts with unallocated funds for contracts of type guaranteed investment?	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 $881
Insurance broker organization code?	4
Insurance broker name	FIRST INDEPENDENT FINANCIAL SE

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

87180458

Policy instance

Insurance contract or identification number	87180458
Number of Individuals Covered	42
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $841
Are there contracts with unallocated funds for contracts of type guaranteed investment?	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 $841
Insurance broker organization code?	4
Insurance broker name	FIRST INDEPENDENT FINANCIAL SE

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

87180458

Policy instance

Insurance contract or identification number	87180458
Number of Individuals Covered	44
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $842
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $842
Insurance broker organization code?	4
Insurance broker name	FIRST INDEPENDENT FINANCIAL SE

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

87180458

Policy instance

Insurance contract or identification number	87180458
Number of Individuals Covered	47
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $964
Are there contracts with unallocated funds for contracts of type guaranteed investment?	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 $964
Insurance broker organization code?	4
Insurance broker name	FIRST INDEPENDENT FINANCIAL SE

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAPB0CW4P

Policy instance

Insurance contract or identification number	GAPB0CW4P
Number of Individuals Covered	47
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $901
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAPB0CW4P

Policy instance

Insurance contract or identification number	GAPB0CW4P
Number of Individuals Covered	45
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $709
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

MCCURTAIN COUNTY BOYS & GIRLS CLUB [EIN = 731506395]

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Company Name:	MCCURTAIN COUNTY BANCSHARES, INC.
Employer identification number (EIN):	731141602
NAIC Classification:	522110
NAIC Description:	Commercial Banking